Imaging of the Postoperative Spine
Section snippets
Imaging of the Noninstrumented Postoperative Spine
Plain film radiography has almost no use in the diagnostic work-up of the noninstrumented postoperative spine. Because of its superior soft-tissue resolution magnetic resonance (MR) is preferred over computed tomography (CT) in imaging the spine after discectomy and/or herniectomy.4 Tissue enhancement is much better detected with magnetic resonance imaging (MRI) than with CT,5, 6 making the differential diagnosis of recurrent disc herniation versus epidural fibrosis much easier. Moreover, bone
The Normal Postoperative Spine
Interpretation of images of the lumbosacral spine in the immediate postoperative period, ie, the first 6 to 8 postsurgical weeks, must be undertaken with caution. Normal, or at least expected, postoperative changes occur within the bones as well as the soft tissues and vary in part depending on the type and extent of surgery and the time since the operation.4
On MRI, the postsurgical absence of bone is sometimes difficult to assess, but can be best demonstrated on axial T1-WI. There is often
Hematoma
Although uncommon, occurring in less than 1% of patients, symptomatic postoperative hemorrhage typically presents hours to days following the spinal surgical procedure. MRI will show mixed blood breakdown products and is more sensitive than CT for both the detection of the hematoma and the evaluation of its extent (Fig. 6). Some hematomas may reach rather large sizes and can extend into the central spinal canal to compress the spinal nerves and/or cord. Such cases potentially constitute medical
Conclusion
Despite advances in imaging technology, imaging of the postoperative spine remains a challenging and difficult issue. As demonstrated, one or a combination of complementary medical imaging modalities may be required in a given patient to diagnose the clinically relevant abnormality and to assist the surgeon in deciding if repeat surgery is necessary, and if so, of what type and at which vertebral level(s). A clear understanding of the indications, limitations, and alternatives available to the
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