E1248. To the Pain: Lumbar Fusion and Complications
  1. Brandi Marsh; SUNY Downstate Medical Center
  2. Zerwa Farooq; SUNY Downstate Medical Center
  3. Neha Doshi; SUNY Downstate Medical Center
  4. Alexandra Perez-Perez; SUNY Downstate Medical Center
  5. Srinivas Kolla; SUNY Downstate Medical Center
Radiologists play an important role in detecting complications of spinal surgery. There must be a foundational understanding of instrumentation and types of lumbar fusion in order to guide the search for complications. Once a basic understanding is achieved, radiologists should know which complications to suspect based on the postsurgical timeline.

Educational Goals / Teaching Points
First we will review the basic instrumentation used in lumbar fusion and the different types of lumbar fusion. Then, we will discuss the immediate, early, and late complications of lumbar fusion.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Immediate complications discussed include injury to nerve roots and hematoma. Early complications reviewed include infection. Late complications discussed include hardware loosening, subsidence, hardware fracture, vertebral insufficiency fracture, heterotopic ossification, pseudoarthrosis/nonunion, and adjacent level disease.

Although radiography is the standard follow-up method for spinal surgery, CT and MRI have particular utility when evaluating for infection and hematoma. STIR is particularly helpful on MRI for diagnosing acute insufficiency fractures and infection. CT is particularly useful for evaluating hardware loosening, subsidence, and subtle hardware fractures. With clear understanding of instrumentation, types of lumbar fusion, and timeline for complications, the radiologist is well-armed to be an invaluable contributor to the clinical care of the post-surgical patient.