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Magnetic Resonance Neurography of the Lumbosacral Plexus in Failed Back Surgery Syndrome

Dessouky, Riham MBBCh, MSc∗,†; Khaleel, Mohammed MD; Khalifa, Dalia N. PhD; Tantawy, Hazim I. PhD; Chhabra, Avneesh MD∗,‡

doi: 10.1097/BRS.0000000000002460

Study Design. Retrospective clinical case series.

Objective. To study the role of magnetic resonance neurography (MRN) of the lumbosacral plexus in management of patients with failed back surgery syndrome (FBSS).

Summary of Background Data. FBSS is one of the major problems in health care, affecting up to 40% of patients after spine surgery. To date, no imaging modality has been used to effectively classify nerve compression, because nerve injuries are challenging to detect on conventional lumbar spine magnetic resonance imaging (MRI). To our knowledge, no previous studies have addressed the use of MRN in FBSS or compared it to lumbar spine MRI.

Methods. From 203 consecutive 3 T MRN studies of lumbosacral plexus in 1 year, 12% (25/203) presented as FBSS. Demographic data, number of previous lumbar MRIs and their findings, MRN findings, interval between MRI and MRN, pre-and post-MRN diagnosis, pain levels, and treatments were recorded. Changes in diagnosis, treatment, and outcomes after MRN were determined.

Results. The final sample of 25 patients had a mean age 62 ± 15 and male to female ratio 1:1.08. Approximately 88% (22/25) had previous lumbar MRI, of which 27% had 3 or more. Most common imaging findings were neuroforaminal stenosis 22.6% (7/31) on MRI and neuropathy 22.9% (19/83) on MRN. Mean interval between MRI and MRN was 13.9 ± 28.3 months. Lumbar MRIs were inconclusive in 36% (8/22). MRN detected 63% (52/83) more findings and changed the diagnosis and treatment in 12% and 48% of FBSS cases, respectively. Favorable outcomes were recorded in 40% to 67% of patients following MRN-guided treatments.

Conclusion. FBSS is a complex problem and MRN of lumbosacral plexus impacts its management by better directing source of symptoms.

Level of Evidence: 4

Department of Radiology, UT Southwestern Medical Center, Dallas, TX

Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt

Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX.

Address correspondence and reprint requests to Avneesh Chhabra, MD, Associate Professor of Radiology and Orthopedic Surgery, Division Chief, Musculoskeletal Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9178; E-mail:

Received 14 June, 2017

Revised 14 September, 2017

Accepted 26 September, 2017

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, royalties.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.