The second issue is the MRIs with gadolinium dye. Gadolinium will differentiate a disc from a scar. Both granulation tissue and the recurrent disc could look alike on a routine MRI. There will be contrast enhancement when there is granulation tissue because it is vascular. However, when there is a disc herniation, the dye will not enhance because the disc is a dead piece of tissue (avascular). When the doctor tries to differentiate between a recurrent disc and a scar, they will inject the dye and get the MRI. If there is a vascular enhancement, then it is granulation tissue and the patient will not need surgical intervention. If there is no enhancement, then it is a recurrent disc and it is avascular, which is why it does not enhance. If the recurrent disc is causing a lot of pain or symptoms to the patient, then the physician may need to discuss a repeated surgery with this patient.