Subchondral marrow changes after laser diskectomy in the lumbar spine: MR imaging findings and clinical correlation.

OBJECTIVE: We examined MR imaging findings and determined the clinical significance of subchondral bone marrow changes in the lumbar spine of holdium:yttrium aluminum garnet laser diskectomy patients. MATERIALS AND METHODS: We retrospectively reviewed the pre- and postoperative MR images of 109 patients with recurrent radiculopathy, lower back pain, or both 1 year after laser diskectomy of 178 disks. From this group of patients, MR images were also obtained in 11 patients with subchondral marrow changes 5-7 years after surgery. These patients were interviewed regarding residual lower back pain. Thirteen asymptomatic laser diskectomy patients also underwent follow-up MR imaging within 1 year of surgery. RESULTS: After surgery, subchondral marrow abnormalities were identified in 41 of 109 laser diskectomy patients. The remaining 68 patients had no postoperative subchondral bone marrow changes. Postoperative subchondral marrow changes were not associated with inflammation of the adjacent disk space and did not affect surgical outcome. Bone marrow changes decreased in size in the 11 patients examined 5-7 years after laser diskectomy, and eight of these patients described their lower back pain as improved. In 13 asymptomatic laser diskectomy patients, one new subchondral marrow abnormality was identified. CONCLUSION: Subchondral marrow abnormalities may occur in the vertebral end plates after holmium:yttrium aluminum garnet laser diskectomy. However, these changes probably do not affect surgical outcomes and appear to resolve over time.

Varicoceles: postoperative prevalence--a prospective study with color Doppler US.

To define the ultrasound (US) prevalence of varicoceles after surgical repair, 28 postoperative patients underwent color Doppler US. A group of 26 control subjects also underwent color Doppler US to establish the prevalence of varicoceles in the healthy population. Eighteen of 28 (64%) patients who underwent color Doppler US scanning 16.4 months, on average, after varicocele repair had evidence of a varicocele, a number similar to that reported in other series for infertile men before surgery. Dominant veins in the postoperative patients were larger (P < .01) than those in the control subjects. Postoperative improvements in sperm parameters and conception rate in our subjects were 58% and 43%, respectively, consistent with findings reported in the literature. The prevalence of varicoceles detected at color Doppler US in our healthy population was 42% (11 of 26). Physical examination after surgery failed to show a varicocele in 20 of 22 (91%) patients examined. The discrepancy between sperm parameters and the results of color Doppler US and physical examination raises questions about the utility of US as a means of evaluation in the postvaricocelectomy patient.