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A Systematic And Intelligent Approach to Postoperative Spine 2012

General Spine

Razia, Rehmani, MD
Robert, Schneider, MD, Non ASSR Member

Poster

Purpose

To review indications and goals of spinal surgery and familiarize the radiologist with spinal instrumentation and techniques.

Methods & Materials

We demonstrate retrospective review of 2D/3D MDCT and MRI in the assessment of surgical failure for studies conducted at our institution over the past one year time frame. A methodical approach is delineated and examples are given to illustrate each diagnostic tool.

Results

Indications for spinal surgery are reviewed and classified into congenital, neoplastic, infectious, traumatic or degenerative. A review of modern spinal surgical approaches and rationale for various techniques is explored and illustrated by examples. We also review possible early and late etiologies of failed back surgery which includes infectious processes such as arachnoiditis, epidural abscess, post-surgical hematomas, canal and foraminal stenosis, residual or recurrent disc herniation versus epidural fibrosis pseudoarthrosis and hardware malpositioning or failure. 2D/3D MDCT images can optimally demonstrate improper hardware positioning and fusion. Myelograms serve a role in correctly evaluating mass effect on the central canal and nerve roots pre and postoperatively.Immediate postcontrast MR is essential to distinguish between scar tissue versus recurrent disc herniation in instances of failed back surgery.

Conclusion

A methodical systematic location-based approach including critical review of thecal sac and central cord, neural foramina, subarticular recesses, facets, epidural space and extradural space can facilitate radiological assessment of post-operative spine. An understanding of spinal biomechanics can enhance imaging interpretation.

References/Financial Disclosures

Imaging of orthopedic appliances and prostheses 1995 New York: Raven Press. Complications of Spinal Instrumentation. Young & al. RSNA, 2007 Imaging of the Postoperative Spine Berquist. Radiologic Clinics of North America - Volume 44, Issue 3 (May 2006) Lumbar Spine Fusion and Stabilization: Hardware, Techniques, and Imaging Appearances. Rutherford & al. RSNA 2007