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Malhotra A, Kalra VB, Wu X, et al. Imaging of lumbar spinal surgery complications. Insights Imaging. 2015;6(6):579-90doi: 10.1007/s13244-015-0435-8.
Malhotra, A., Kalra, V. B., Wu, X., Grant, R., Bronen, R. A., & Abbed, K. M. (2015). Imaging of lumbar spinal surgery complications. Insights into imaging, 6(6), 579-90. https://doi.org/10.1007/s13244-015-0435-8
Malhotra, Ajay, et al. "Imaging of lumbar spinal surgery complications." Insights into imaging vol. 6,6 (2015): 579-90. doi: https://doi.org/10.1007/s13244-015-0435-8
Malhotra A, Kalra VB, Wu X, Grant R, Bronen RA, Abbed KM. Imaging of lumbar spinal surgery complications. Insights Imaging. 2015 Dec;6(6):579-90. doi: 10.1007/s13244-015-0435-8. Epub 2015 Oct 02. PMID: 26432098; PMCID: PMC4656239.
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Insights Imaging. 2015 Dec;6(6):579-90. doi: 10.1007/s13244-015-0435-8. Epub 2015 Oct 02.

Imaging of lumbar spinal surgery complications.

Insights into imaging

Ajay Malhotra, Vivek B Kalra, Xiao Wu, Ryan Grant, Richard A Bronen, Khalid M Abbed

Affiliations

  1. Department of Diagnostic Radiology, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT, 06520-8042, USA. [email protected].
  2. Department of Diagnostic Radiology, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT, 06520-8042, USA. [email protected].
  3. Department of Diagnostic Radiology, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT, 06520-8042, USA. [email protected].
  4. Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA. [email protected].
  5. Department of Diagnostic Radiology, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT, 06520-8042, USA. [email protected].
  6. Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA. [email protected].

PMID: 26432098 PMCID: PMC4656239 DOI: 10.1007/s13244-015-0435-8

Abstract

UNLABELLED: Lumbar spine surgery for spinal stenosis is a frequently performed procedure and was the fastest growing type of surgery in the US from 1980 to 2000. With increasing surgical invasiveness, postoperative complications also tend to be higher. Cross-sectional imaging techniques (CT and MRI) are more sensitive than radiographs and play an increasingly important role in evaluation of patients with lumbar spine surgery. Their use in patients with metallic implants is somewhat limited by artefacts, which can obscure pathology and decrease accuracy and reader confidence. Metal artefact reduction techniques have been developed, which can significantly improve image quality and enable early detection of postoperative complications. Complications can occur throughout postoperative course. Early complications include hardware displacement, incidental durotomy, postoperative collections-most commonly seroma, and less likely haematoma and/or infection. Incidental durotomy with CSF leak causing intracranial hypotension has characteristic MR brain findings and diagnosis of occult leak sites have been improved with use of dynamic CT myelography. Haematomas, even when compressing the thecal sac, are usually asymptomatic. Early infection, with nonspecific MR findings, can be diagnosed accurately using dual radiotracer studies. Delayed complications include loosening, hardware failure, symptomatic new or recurrent disc herniation, peri-/epidural fibrosis, arachnoiditis, and radiculitis.

TEACHING POINTS: • CT and MRI play an increasingly important role in evaluation of patients with lumbar spine surgery • Complications can occur throughout the postoperative course and early detection is critical • Artefact reduction techniques can improve image quality for early and improved detection of complications.

Keywords: Artefact; CT; Complications; Lumbar spinal surgeries; MR

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