E2277. “Beyond the Barriers”: Overcoming the Challenges Faced in Imaging of Postoperative Spine Complications
Rajarama Ravivarma N;
The rate of spine surgeries done annually has been steadily increasing for the past two decades due to the upheavals in surgical techniques and devices. Neck pain and lower back pain are the two main indications for spinal surgery. The increasing numbers of spinal surgeries are resulting in increasing numbers of postoperative imaging studies for radiologists to interpret. Persistent pain or development of new symptoms is indication for imaging in postoperative spine. However, radiologists face several challenges when imaging in postoperative period due to significant soft tissue and bone changes which are expected in this period. Imaging plays a critical role in the postoperative lumbar spine evaluation. The initial clinical manifestations and imaging characteristics of the preoperative spinal abnormalities, type of surgery performed, and length of time since surgery are helpful for the radiologist for accurate interpretation of the postoperative spinal imaging study. A thorough knowledge of expected postoperative changes and utilization of optimal imaging protocols helps in accurate diagnosis and management. In addition, proper knowledge of the spinal surgery techniques, approaches and devices helps in differentiating expected postoperative findings from abnormalities and complications. Postoperative complications can be classified chronologically as immediate, early and late postoperative period which will be discussed in conjunction with clinical symptoms, operative details and imaging. A proper clinico-radiological algorithm has to be framed for optimal diagnosis and management of postoperative complications.
Educational Goals / Teaching Points
To describe expected postoperative changes and optimal imaging modalities depending on postoperative time frame.
To discuss important modifications in imaging protocols to overcome the diagnostic challenges related to postoperative changes.
To emphasize the importance of detailed clinical input in optimizing the imaging protocol as well as to obtain the correct diagnosis in a case-based approach.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Radiography with antero-posterior, lateral, oblique and flexion extension views is the primary imaging modality for postoperative evaluation of spine. Implant location, fusion status and spinal stability can be elicited by series of radiographs. However, it is limited by poor soft tissue resolution. Computed tomography is the best tool for the assessment of instrument related complications. All soft tissue related complications are well visualized with magnetic resonance imaging.
This educational exhibit helps the reader to understand the normal and abnormal postoperative changes of spine in a chronological pattern and also provides unique insight to how clinical input plays a crucial role in postoperative spine imaging with case examples.