The importance of plain radiography in the evaluation of radiculopathy after failed diskectomy

Herniated disks in the lumbar spine are the leading cause of patient visits to spinal surgeons in the United States. Although magnetic resonance imaging (MRI) is the diagnostic test of choice in patients with a herniated disk, plain radiographs can provide important information and should remain a standard part of the diagnostic workup in any patient indicated for revision spine surgery. This article describes a case of a 36-year-old man with a >6-month history of worsening lumbar radiculopathy who was diagnosed with lumbar disk herniations on the basis of MRI alone and underwent 2 unsuccessful attempts at microdiskectomy at another institution. Further workup by the senior author (A.C.H.), which included initial plain radiographs followed by computed tomography, demonstrated a large disk herniation with a markedly calcified annulus as the continuing source of neurologic compression. The patient underwent revision lumbar decompression with attention being paid to the removal of the calcified annulus and disk material that resulted in complete resolution of his symptoms. Although MRI is the diagnostic test of choice in the evaluation of spinal pathology, plain radiographs can provide important additional information that can be vital to the successful outcome of patients undergoing revision spinal surgery.