Spine: scar versus recurrent disc on MRI: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Spine: scar versus recurrent disc on MRI

Sample item

A man has recurrent sciatica 6 months after lumbar discectomy. A gadolinium MRI shows soft tissue around the nerve root. Which finding favours epidural scar rather than a recurrent disc herniation?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Homogeneous enhancement of the tissue

Epidural fibrosis is vascular and enhances homogeneously and quickly after gadolinium. A recurrent disc fragment is avascular and shows only a thin peripheral rim of enhancement from the surrounding granulation tissue, while its core stays dark. Scar also tends to surround the root rather than displace the sac.

Option by option

  • A. Enhancement only of the peripheral rim

    A rim-only pattern is the typical appearance of a recurrent disc fragment.

  • B. A mass effect that displaces the thecal sac

    Significant displacement of the thecal sac is more typical of a recurrent herniation than of scar.

  • C. No enhancement of the tissue at all

    Non-enhancing tissue is typical of avascular disc material.

  • D. Homogeneous enhancement of the tissue (correct)

    Correct. Scar tissue takes up contrast uniformly because it is vascular.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Homogeneous enhancement of the tissue. Epidural fibrosis is vascular and enhances homogeneously and quickly after gadolinium.

Why is "Enhancement only of the peripheral rim" not the answer?

A rim-only pattern is the typical appearance of a recurrent disc fragment.

Why is "A mass effect that displaces the thecal sac" not the answer?

Significant displacement of the thecal sac is more typical of a recurrent herniation than of scar.

Why is "No enhancement of the tissue at all" not the answer?

Non-enhancing tissue is typical of avascular disc material.

What concept does this question test?

It tests Spine: scar versus recurrent disc on MRI in Orthopaedics. A recurrent disc fragment is avascular and shows only a thin peripheral rim of enhancement from the surrounding granulation tissue, while its core stays dark. Scar also tends to surround the root rather than displace the sac.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Spine: scar versus recurrent disc on MRI?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.