![]() ![]() Moreover, a dual Ga-67 and Tc-99m-MDP study can increase the overall specificity of the examination to 81% with a sensitivity of 73%. Although Ga-67 is less sensitive (73%), it is more specific (61%) than skeletal scintigraphy. Ga-67 scintigraphy combined with SPECT/CT can be used to evaluate suspected spinal infection in patients who have undergone recent spine interventions. The most important studies in this setting are gallium scan, indium 111-tagged white blood cell (WBC) scan, single-photon emission computerized tomography/computed tomography (SPECT/CT), and positron emission tomography (PET) scan. These examinations are typically used in certain situations, such as in patients in whom MRI is contraindicated or if MRI and CT are equivocal. Nuclear medicine studies are also part of the diagnostic workup of the postoperative spine. ![]() 2) and significantly improve image quality, including multi-acquisition variable resonance image combination selective (MAVRIC-SL, GE HealthCare ®), WARP (Siemens Healthineers ®), and slice encoding metal artifact correction (SEMAC, Siemens Healthineers ®). New techniques are currently available to reduce artifacts (Fig. Some alternatives to reduce these artifacts include increasing the bandwidth, higher matrix size and/or the turbo factor, lower magnetic field, acquisition in fast spin echo and short tau inversion recovery (STIR), and techniques for fat suppression. It allows the evaluation of the vertebral canal, nerve roots, bone marrow, and paravertebral soft tissues.Īlthough there are no major concerns regarding spinal fusion-hardware for the safety of the patient undergoing an MR procedure, they can still significantly impair the evaluation of MRI images due to magnetic susceptibility artifacts. MRI is the most reliable choice to assess postoperative complications due to its excellent soft-tissue resolution. CT myelography can be used as an alternative to evaluate the exiting nerve roots and spinal canal in patients with restriction to magnetic resonance imaging (MRI). Beam hardening artifacts may obscure the abnormalities, although artifact reduction software can aid to reduce this issue. CT is also helpful to evaluate hardware-related complications, such as malposition, failure, or loosening. 1B), which is expected to occur within 9 months after surgery, and it is better assessed by coronal and sagittal CT reformats. Computed tomography (CT)ĬT is the most accurate modality for assessing mineralized bone structures, including evaluation of spine fusion progression (Fig. Reasons to perform postoperative imaging include reassuring the patient about adequate healing and surgery success, identifying asymptomatic hardware migration or failure, and documenting clinical status in the medical record. ![]() Panoramic radiographs play a major role in the preoperative evaluation for the detection of scoliosis, malalignment, vertebral counting, and assessment of transitional vertebrae to ensure that the surgery occurs at the correct level, serving also as a reference for intraoperative fluoroscopy, especially to check spine levels and confirm appropriate position and location of implants. The purpose of this pictorial essay is to illustrate and discuss the more frequently used spine surgical interventions and their imaging characteristics, with an emphasis on classical decompression and fusion/stabilization procedures. It is essential to be familiar with the main types of surgical techniques and imaging characteristics of each one, including the type and correct positioning of hardware involved, to differentiate normal and abnormal postoperative appearances. In this context, there is increasing importance of the radiologist in the adequate interpretation of postoperative images, as well as in the choice of the most appropriate modality for each case, especially among radiographs, computed tomography, magnetic resonance imaging and nuclear medicine. Therefore, it helps the surgeon in the appropriate management of cases. Spinal surgical procedures are becoming more common over the years, and imaging studies can be requested in the postoperative setting, such as a baseline study when implants are used, or when there is a new postoperative issue reported by the patient or even as routine surveillance. ![]()
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