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A Pictorial Review of Lumbar Spine Surgical Approaches, Techniques, and Complications 2014

Category General Spine Austin Faulkner, MD, MS, BS Chris Kolze, MD Austin Bourgeois, MD, BS Yong Bradley, MD Purpose Imaging plays an important role in the preoperative planning and postoperative care of patients undergoing lumbar spine surgery. A working knowledge of surgical techniques, approaches, objectives, and complications allows the radiologist to add maximal value when interpreting these exams. This educational exhibit explores these factors and provides a practical framework for lumbar spine image interpretation. Materials & Methods A retrospective medical record review from 2007-2013 was performed to obtain illustrative cases of common and emerging surgical approaches such PLIF, TLIP, ALIF, and XLIF. Complications such as graft subsidence, cage migration/extrusion, retained/recurrent disc, epidural bone formation, durotomy, pedicle breach, and epidural hematoma are explored in a pictorial format. Emerging surgical methods including minimally invasive access devices, 3-D stereotactic image guidance, and bone morphogenic protein are also included. Results Accurate interpretation of lumbar spine MRI proves a valuable adjunct to patient selection and operative planning. Both intraoperative and preoperative CT data sets can be used in intraoperative image-guided stereotaxis. MRI, CT, and CT myelogram play an important role in post-operative troubleshooting when the interpretive physician has a sound clinical perspective on the complications and limitations of these procedures. Conclusion As both imaging and surgical methodology continue to improve, imaging may play a more critical role in patient care. Much of the clinical relevance of lumbar spine imaging relies upon the radiologist having a robust clinical perspective on the goals, techniques, and drawbacks to surgical intervention. References 1. Albee FH: Transplantation of a portion of the tibia into the spine for Pott's disease: a preliminary report. JAMA 57: 885, 1911 2. Amiot LP, Lang K, Putzier M, Zippel H, Labelle H: Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine. Spine 25: 606–614, 2000 3. Chen HJ: Clinical experiences in neuronavigation. Stereotact Funct Neurosurg 76:145–147, 2001 4. Cottington GM, Riden JM, Ferguseon Jr AB: Osteomyelitis since the advent of antibiotics; a study of infants and children CORR 14:97–101, 1911