Devoted to diagnostic and interventional spine imaging and therapeutics


Post-operative Paraspinal Fluid Collections: Classification and Management Strategies 2014

Category General Spine Nikhil K. Jain, MD, MBA Orlando Ortiz, MD, MBA, FACR Kimberly Dao, MD Purpose The educational exhibit will describe the various types of paraspinal post-operative fluid collections with respect to their imaging findings, characterize them, and suggest possible management strategies. Materials & Methods 1. Review of types of paraspinal post-operative fluid collections. 2. Review the imaging findings of collections and identify characteristics that help differentiate them. 3. Review suggested management strategies. Results 1. Introduction 2. Hematoma: Epidemiology, Clinical Presentation, Imaging, Management 3. Seroma: Epidemiology, Clinical Presentation, Imaging, Management 4. Pseudomeningocele: Epidemiology, Clinical Presentation, Imaging, Management 5. Abscess: Epidemiology, Clinical Presentation, Imaging, Management Conclusion Paraspinal fluid collections are often seen after spine surgery. This increased frequency is likely due to surgical manipulation, but may also reflect other factors such as the extent of the spine surgery, patient co-morbidities and patient coagulation status. Post-operative imaging modalities include myelography, ultrasound, radionuclide scanning, CT and MRI. MRI remains the best study to visualize and define the spectrum of paraspinal fluid collections. Management of paraspinal fluid collections is challenging. Communication between the radiologist and surgeon is extremely helpful in managing these complex situations. References 1. Berquist TH. Imaging of the postoperative spine. Radiol Clin North Am. 2006 May; 44(3):407-18. 2. Ross JS. Complications. In Specialty Imaging: Postoperative Spine Amirsys 2012; 5(2-144) 3. Hayashi D, Roemer FW, Mian A, et al. Imaging features of postoperative complications after spinal surgery and instrumentation. AJR Am J Roentgenol. 2012;199:W123-9. 4. Carreon, Leah Y.; Puno, Rolando M.; Lenke, Lawrence G.; et al. Non-neurologic complications following surgery for adolescent idiopathic scoliosis. J Bone Joint Surg Am.89,11. 2427-2732. (2007). 5. Rutherford EE, Tarplett LJ, Davies EM, et al. Lumbar spine fusion and stabilization: hardware, techniques, and imaging appearances. Radiographics. 2007 Nov-Dec;27(6):1737-49. 6. Kalanithi PS, Patil CG, Boakye M. National complication rates and disposition after posterior lumbar fusion for acquired spondylolisthesis. Spine (Phila Pa 1976). 2009 Aug 15;34(18):1963-9. 7. Van Goethem JWM, Salgado R. Imaging of the postoperative spine : discectomy and herniectomy. In Spinal Imaging, Van Goethem J, van den Hauwe L, Parizel PM (eds) 2007 Springer New York 371-389 8. Naidich TP, Gologorsky Y, Fatterpekar GM, et al. Complications of surgery for decompression of spinal stenosis and disc disease. In Naidich TP, Castillo M, Cha S, Raybaud C, Smirniotopoulos J, Kolias S, Kleinman GM (eds) Imaging of the Spine Saunders 2011: 513-546. 9. Uribe J, Moza K, Jimenez O, Green B, et al. Delayed postoperative spinal epidural hematomas. The Spine Journal 2003;3:125-129. 10. Van Goethem JWM, Parizel PM, Jinkins JR. Review article: MRI of the postoperative lumbar spine. Neuroradiology 2002;44:723-39. 11. Kreppel D, Antoniadis G, Seeling W. Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev. 2003;26:1-49. 12. Sawkar AA, Swischuk LE, Jadhav SP. Morel-lavallee seroma: a review of two cases in the lumbar region in the adolescent. Emerg Radiol 2011;18:495-498. 13. Garrett MP, Kakarla UK, Porter RW, et al. Formation of painful seroma and edema after the use of recombinant human bone morphogenetic protein-2 in posterolateral lumbar spine fusions. Neurosurgery. 2010;66:1044-9. 14. Benglis D, Wang MY, Levi AD. A comprehensive review of the safety profile of bone morphogenetic protein in spine surgery. Neurosurgery 2008 May;62(5 Suppl 2):ONS423-31. 15. Shahlaie K, Kim KD. Occipitocervical fusion using recombinant human bone morphogenetic protein-2: adverse effects due to tissue swelling and seroma. Spine 2008;33:2361-6. 16. Smucker JD, Rhee JM, Singh K, et al. Increased swelling complications associated with off-label usage of rhBMP-2 in the anterior cervical spine. Spine 2006;31:2813-9. 17. Hoffmann MF, Jones CB, Sietsema DL. Complications of rhBMP-2 utilization for posterolateral lumbar fusions requiring reoperation: a single practice, retrospective case series report. Spine J 2013; 2013 Aug 22. pii: S1529-9430(13)00697-9. doi: 10.1016/j.spinee.2013.06.022. [Epub ahead of print] 18. Weng YJ, Cheng CC, Li YY, et al. Management of giant pseudomeningoceles after spinal surgery. BMC Musculoskelet Disord. 2010;11:53. 19. Hawk MW, Kim KD. Review of spinal pseudomeningoceles and cerebrospinal fluid fistulas. Neurosurg Focus 2000 9:e5. 20. Ross JS. MR imaging of the postoperative lumbar spine. MRI Clinics of North America 1999;7:513-524. 21. Thakkar RS, Malloy JP 4th, Thakkar SC, et al. Imaging the postoperative spine. Radiol Clin North Am. 2012;50:731-47. 22. Lee KS, Hardy IM: Postlaminectomy lumbar pseudomeningocele: report of four cases. Neurosurgery 1992 30:111-114 23. Richards S. Delayed infections following posterior spinal instrumentation for treatment of idiopathic scoliosis. J Bone Join Surg (Am) 1995;77-A:524-9 24. Katonis P, Tzermiadianos M, Papagelopoulos P, et al. Postoperative infections of the thoracic and lumbar spine: a review of 18 cases. Clin Orthop Relat Res 2007;454:114-99. 25. Diehn FE. Imaging of spine infection. Radiol Clin North Am. 2012;50:777-98.