Semin Musculoskelet Radiol 2019; 23(02): e56-e79
DOI: 10.1055/s-0038-1677468
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Update on Imaging of Spinal Fixation Hardware

Blair A. Winegar
1   Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona
,
Matthew D. Kay
1   Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona
,
Tyson S. Chadaz
1   Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona
,
Mihra S. Taljanovic
2   Department of Medical Imaging & Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, Arizona
,
Kenneth A. Hood
3   Department of Orthopaedic Surgery, University of Arizona, College of Medicine, Tucson, Arizona
,
Tim B. Hunter
1   Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona
› Author Affiliations
Further Information

Publication History

Publication Date:
29 March 2019 (online)

Abstract

This article discusses instrumented spinal surgeries, the radiologic assessment of spinal fixation hardware, and the potential complications of spinal hardware. Radiography is the standard for the postoperative assessment of spinal hardware. Computed tomography and magnetic resonance imaging play a valuable role in the detection of hardware and postsurgical-related complications such as infection, pseudarthrosis, and malpositioned instrumentation. Familiarity with the normal imaging appearance of implanted spinal hardware along with the expected progression of normal postoperative osseous arthrodesis enables recognition of potential complications and helps facilitate appropriate clinical management.

 
  • References

  • 1 Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine 2012; 37 (01) 67-76
  • 2 Saifi C, Fein AW, Cazzulino A. , et al. Trends in resource utilization and rate of cervical disc arthroplasty and anterior cervical discectomy and fusion throughout the United States from 2006 to 2013. Spine J 2018; 18 (06) 1022-1029
  • 3 Raad M, Donaldson CJ, El Dafrawy MH. , et al. Trends in isolated lumbar spinal stenosis surgery among working US adults aged 40–64 years, 2010–2014. J Neurosurg Spine 2018; 29 (02) 169-175
  • 4 Young PM, Berquist TH, Bancroft LW, Peterson JJ. Complications of spinal instrumentation. Radiographics 2007; 27 (03) 775-789
  • 5 Boden SD. Overview of the biology of lumbar spine fusion and principles for selecting a bone graft substitute. Spine 2002; 27 (16) (Suppl. 01) S26-S31
  • 6 Gupta A, Kukkar N, Sharif K, Main BJ, Albers CE, El-Amin Iii SF. Bone graft substitutes for spine fusion: a brief review. World J Orthop 2015; 6 (06) 449-456
  • 7 Moftakhar R, Trost GR. Anterior cervical plates: a historical perspective. Neurosurg Focus 2004; 16 (01) E8
  • 8 Silber JS, Anderson DG, Daffner SD. , et al. Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine 2003; 28 (02) 134-139
  • 9 Fernyhough JC, Schimandle JJ, Weigel MC, Edwards CC, Levine AM. Chronic donor site pain complicating bone graft harvesting from the posterior iliac crest for spinal fusion. Spine 1992; 17 (12) 1474-1480
  • 10 Xie Y, Chopin D, Hardouin P, Lu J. Clinical, radiological and histological study of the failure of cervical interbody fusions with bone substitutes. Eur Spine J 2006; 15 (08) 1196-1203
  • 11 Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 1958; 40-A (03) 607-624
  • 12 Cabraja M, Oezdemir S, Koeppen D, Kroppenstedt S. Anterior cervical discectomy and fusion: comparison of titanium and polyetheretherketone cages. BMC Musculoskelet Disord 2012; 13: 172
  • 13 Petscavage-Thomas JM, Ha AS. Imaging current spine hardware: part 1, cervical spine and fracture fixation. AJR Am J Roentgenol 2014; 203 (02) 394-405
  • 14 Whitecloud III TS. Modern alternatives and techniques for one-level discectomy and fusion. Clin Orthop Relat Res 1999; (359) 67-76
  • 15 Haid RW, Foley KT, Rodts GE, Barnes B. The Cervical Spine Study Group anterior cervical plate nomenclature. Neurosurg Focus 2002; 12 (01) E15
  • 16 Mayr MT, Subach BR, Comey CH, Rodts GE, Haid Jr RW. Cervical spinal stenosis: outcome after anterior corpectomy, allograft reconstruction, and instrumentation. J Neurosurg 2002; 96 (1, Suppl): 10-16
  • 17 Scholz M, Schnake KJ, Pingel A, Hoffmann R, Kandziora F. A new zero-profile implant for stand-alone anterior cervical interbody fusion. Clin Orthop Relat Res 2011; 469 (03) 666-673
  • 18 Schmidt R, Wilke HJ, Claes L, Puhl W, Richter M. Effect of constrained posterior screw and rod systems for primary stability: biomechanical in vitro comparison of various instrumentations in a single-level corpectomy model. Eur Spine J 2005; 14 (04) 372-380
  • 19 Epstein NE. Anterior dynamic plates in complex cervical reconstructive surgeries. J Spinal Disord Tech 2002; 15 (03) 221-227 ; discussion 227–228
  • 20 Hadra BE. Wiring the spinous processes in Pott's disease. JBJS 1891; 4: 206-210
  • 21 Liu JK, Das K. Posterior fusion of the subaxial cervical spine: indications and techniques. Neurosurg Focus 2001; 10 (04) E7
  • 22 Sawin PD, Sonntag VKH. Techniques of posterior subaxial cervical fusion. Oper Techniques Neurosurg 1998; 1: 72-83
  • 23 Levine AM, Mazel C, Roy-Camille R. Management of fracture separations of the articular mass using posterior cervical plating. Spine 1992; 17 (10, Suppl): S447-S454
  • 24 Jones EL, Heller JG, Silcox DH, Hutton WC. Cervical pedicle screws versus lateral mass screws. Anatomic feasibility and biomechanical comparison. Spine 1997; 22 (09) 977-982
  • 25 Kast E, Mohr K, Richter HP, Börm W. Complications of transpedicular screw fixation in the cervical spine. Eur Spine J 2006; 15 (03) 327-334
  • 26 Park DK, Lin EL, Phillips FM. Index and adjacent level kinematics after cervical disc replacement and anterior fusion: in vivo quantitative radiographic analysis. Spine 2011; 36 (09) 721-730
  • 27 Leven D, Meaike J, Radcliff K, Qureshi S. Cervical disc replacement surgery: indications, technique, and technical pearls. Curr Rev Musculoskelet Med 2017; 10 (02) 160-169
  • 28 Koech F, Ackland HM, Varma DK, Williamson OD, Malham GM. Nonoperative management of type II odontoid fractures in the elderly. Spine 2008; 33 (26) 2881-2886
  • 29 Böhler J. Anterior stabilization for acute fractures and non-unions of the dens. J Bone Joint Surg Am 1982; 64 (01) 18-27
  • 30 Collins I, Min WK. Anterior screw fixation of type II odontoid fractures in the elderly. J Trauma 2008; 65 (05) 1083-1087
  • 31 Brooks AL, Jenkins EB. Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg Am 1978; 60 (03) 279-284
  • 32 Kukreja S, Ambekar S, Sin AH, Nanda A. Occipitocervical fusion surgery: review of operative techniques and results. J Neurol Surg B Skull Base 2015; 76 (05) 331-339
  • 33 Pan J, Huang D, Hao D. , et al. Occipitocervical fusion: fix to C2 or C3?. Clin Neurol Neurosurg 2014; 127: 134-139
  • 34 Bhatia R, Desouza RM, Bull J, Casey AT. Rigid occipitocervical fixation: indications, outcomes, and complications in the modern era. J Neurosurg Spine 2013; 18 (04) 333-339
  • 35 Harrington PR. Treatment of scoliosis. Correction and internal fixation by spine instrumentation. J Bone Joint Surg Am 1962; 44-A: 591-610
  • 36 Theruvath AS, Mahajan R, Gururaj M, Chhabra HS, Tandon V, Nanda A. Correction maneuvers in scoliosis surgery: an overview. Kerala J Orthop 2012; 25: 73-77
  • 37 Maruyama T, Takeshita K. Surgery for idiopathic scoliosis: currently applied techniques. Clin Med Pediatr 2009; 3: 39-44
  • 38 Betz RR, Harms J, Clements III DH. , et al. Comparison of anterior and posterior instrumentation for correction of adolescent thoracic idiopathic scoliosis. Spine 1999; 24 (03) 225-239
  • 39 Mack MJ, Regan JJ, McAfee PC, Picetti G, Ben-Yishay A, Acuff TE. Video-assisted thoracic surgery for the anterior approach to the thoracic spine. Ann Thorac Surg 1995; 59 (05) 1100-1106
  • 40 Helenius I. Anterior surgery for adolescent idiopathic scoliosis. J Child Orthop 2013; 7 (01) 63-68
  • 41 Dwyer AF. Experience of anterior correction of scoliosis. Clin Orthop Relat Res 1973; (93) 191-206
  • 42 Suk SI, Kim JH, Kim SS, Lee JJ, Han YT. Thoracoplasty in thoracic adolescent idiopathic scoliosis. Spine 2008; 33 (10) 1061-1067
  • 43 Ozgen S, Naderi S, Ozek MM, Pamir MN. A retrospective review of cervical corpectomy: indications, complications and outcome. Acta Neurochir (Wien) 2004; 146 (10) 1099-1105 ; discussion 1105
  • 44 Papanastassiou ID, Gerochristou M, Aghayev K, Vrionis FD. Defining the indications, types and biomaterials of corpectomy cages in the thoracolumbar spine. Expert Rev Med Devices 2013; 10 (02) 269-279
  • 45 Lau D, Chou D. Posterior thoracic corpectomy with cage reconstruction for metastatic spinal tumors: comparing the mini-open approach to the open approach. J Neurosurg Spine 2015; 23 (02) 217-227
  • 46 Sasani M, Ozer AF. Single-stage posterior corpectomy and expandable cage placement for treatment of thoracic or lumbar burst fractures. Spine 2009; 34 (01) E33-E40
  • 47 Rutherford EE, Tarplett LJ, Davies EM, Harley JM, King LJ. Lumbar spine fusion and stabilization: hardware, techniques, and imaging appearances. Radiographics 2007; 27 (06) 1737-1749
  • 48 Wu J, Luo D, Ye X, Luo X, Yan L, Qian H. Anatomy-related risk factors for the subsidence of titanium mesh cage in cervical reconstruction after one-level corpectomy. Int J Clin Exp Med 2015; 8 (05) 7405-7411
  • 49 Thaker RA, Gautam VK. Study of vertebral body replacement with reconstruction spinal cages in dorsolumbar traumatic and Koch's spine. Asian Spine J 2014; 8 (06) 786-792
  • 50 Ciappetta P, Boriani S, Fava GP. A carbon fiber reinforced polymer cage for vertebral body replacement: technical note. Neurosurgery 1997; 41 (05) 1203-1206
  • 51 Hide IG, Gangi A. Percutaneous vertebroplasty: history, technique and current perspectives. Clin Radiol 2004; 59 (06) 461-467
  • 52 Kim AK, Jensen ME, Dion JE, Schweickert PA, Kaufmann TJ, Kallmes DF. Unilateral transpedicular percutaneous vertebroplasty: initial experience. Radiology 2002; 222 (03) 737-741
  • 53 Levine SA, Perin LA, Hayes D, Hayes WS. An evidence-based evaluation of percutaneous vertebroplasty. Manag Care 2000; 9 (03) 56-60 , 63
  • 54 He Z, Zhai Q, Hu M. , et al. Bone cements for percutaneous vertebroplasty and balloon kyphoplasty: current status and future developments. J Orthop Translat 2014; 3 (01) 1-11
  • 55 Deramond H, Wright NT, Belkoff SM. Temperature elevation caused by bone cement polymerization during vertebroplasty. Bone 1999; 25 (2, Suppl): 17S-21S
  • 56 Feng L, Shen JM, Feng C, Chen J, Wu Y. Comparison of radiofrequency kyphoplasty (RFK) and balloon kyphoplasty (BKP) in the treatment of vertebral compression fractures: a meta-analysis. Medicine (Baltimore) 2017; 96 (25) e7150
  • 57 Miyashita T, Ataka H, Kato K, Tanno T. Good clinical outcomes and fusion rate of facet fusion with a percutaneous pedicle screw system for degenerative lumbar spondylolisthesis: minimally invasive evolution of posterolateral fusion. Spine 2015; 40 (09) E552-E557
  • 58 Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg 2015; 1 (01) 2-18
  • 59 Han X, Zhu Y, Cui C, Wu Y. A meta-analysis of circumferential fusion versus instrumented posterolateral fusion in the lumbar spine. Spine 2009; 34 (17) E618-E625
  • 60 Briggs H, Milligan PR. Chip fusion of the low back following exploration of the spinal canal. J Bone Joint Surg Am 1944; 26: 125-130
  • 61 Figueiredo N, Martins JW, Arruda AA. , et al. TLIF—transforaminal lumbar interbody fusion. Arq Neuropsiquiatr 2004; 62 (3B): 815-820
  • 62 Rao PJ, Loganathan A, Yeung V, Mobbs RJ. Outcomes of anterior lumbar interbody fusion surgery based on indication: a prospective study. Neurosurgery 2015; 76 (01) 7-23 ; discussion 23–24
  • 63 Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 2006; 6 (04) 435-443
  • 64 Mayer HM. A new microsurgical technique for minimally invasive anterior lumbar interbody fusion. Spine 1997; 22 (06) 691-699 ; discussion 700
  • 65 Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion?. Spine J 2004; 4 (6, Suppl): 190S-194S
  • 66 Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine 2004; 29 (17) 1938-1944
  • 67 Hudson WR, Gee JE, Billys JB, Castellvi AE. Hybrid dynamic stabilization with posterior spinal fusion in the lumbar spine. SAS J 2011; 5 (02) 36-43
  • 68 Salzmann SN, Plais N, Shue J, Girardi FP. Lumbar disc replacement surgery-successes and obstacles to widespread adoption. Curr Rev Musculoskelet Med 2017; 10 (02) 153-159
  • 69 Zhou ZJ, Xia P, Zhao X, Fang XQ, Zhao FD, Fan SW. Can posterior dynamic stabilization reduce the risk of adjacent segment deterioration?. Turk Neurosurg 2013; 23 (05) 579-589
  • 70 Sengupta DK, Herkowitz HN. Pedicle screw-based posterior dynamic stabilization: literature review. Adv Orthop 2012; 2012: 424268
  • 71 Ozer AF, Suzer T, Sasani M. , et al. Simple facet joint repair with dynamic pedicular system: technical note and case series. J Craniovertebr Junction Spine 2015; 6 (02) 65-68
  • 72 Anekstein Y, Floman Y, Smorgick Y, Rand N, Millgram M, Mirovsky Y. Seven years follow-up for total lumbar facet joint replacement (TOPS) in the management of lumbar spinal stenosis and degenerative spondylolisthesis. Eur Spine J 2015; 24 (10) 2306-2314
  • 73 Gala RJ, Russo GS, Whang PG. Interspinous implants to treat spinal stenosis. Curr Rev Musculoskelet Med 2017; 10 (02) 182-188
  • 74 Wu AM, Zhou Y, Li QL. , et al. Interspinous spacer versus traditional decompressive surgery for lumbar spinal stenosis: a systematic review and meta-analysis. PLoS One 2014; 9 (05) e97142
  • 75 Malhotra A, Kalra VB, Wu X, Grant R, Bronen RA, Abbed KM. Imaging of lumbar spinal surgery complications. Insights Imaging 2015; 6 (06) 579-590
  • 76 Aoude A, Ghadakzadeh S, Alhamzah H. , et al. Postoperative assessment of pedicle screws and management of breaches: a survey among Canadian spine surgeons and a new scoring system. Asian Spine J 2018; 12 (01) 37-46
  • 77 Isik C, Kose KC, Inanmaz ME, Tagil SM, Sarman H. The mechanisms of medial pedicle wall violation: insertion method is as important as correct cannulation of the pedicle. Adv Orthop 2014; 2014: 283783
  • 78 Nakashima H, Yukawa Y, Imagama S. , et al. Complications of cervical pedicle screw fixation for nontraumatic lesions: a multicenter study of 84 patients. J Neurosurg Spine 2012; 16 (03) 238-247
  • 79 Murtagh RD, Quencer RM, Cohen DS, Yue JJ, Sklar EL. Normal and abnormal imaging findings in lumbar total disk replacement: devices and complications. Radiographics 2009; 29 (01) 105-118
  • 80 Padovani B, Kasriel O, Brunner P, Peretti-Viton P. Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty. AJNR Am J Neuroradiol 1999; 20 (03) 375-377
  • 81 Nouh MR. Spinal fusion-hardware construct: basic concepts and imaging review. World J Radiol 2012; 4 (05) 193-207
  • 82 Leven D, Cho SK. Pseudarthrosis of the cervical spine: risk factors, diagnosis and management. Asian Spine J 2016; 10 (04) 776-786
  • 83 Ray CD. Threaded titanium cages for lumbar interbody fusions. Spine 1997; 22 (06) 667-679 ; discussion 679–680
  • 84 Cannada LK, Scherping SC, Yoo JU, Jones PK, Emery SE. Pseudoarthrosis of the cervical spine: a comparison of radiographic diagnostic measures. Spine 2003; 28 (01) 46-51
  • 85 Gruskay JA, Webb ML, Grauer JN. Methods of evaluating lumbar and cervical fusion. Spine J 2014; 14 (03) 531-539
  • 86 Jacobson JA, Starok M, Pathria MN, Garfin SR. Pseudarthrosis: US evaluation after posterolateral spinal fusion: work in progress. Radiology 1997; 204 (03) 853-858
  • 87 Albert TJ, Pinto M, Smith MD, Balderston RA, Cotler JM, Park CH. Accuracy of SPECT scanning in diagnosing pseudoarthrosis: a prospective study. J Spinal Disord 1998; 11 (03) 197-199
  • 88 Peters M, Willems P, Weijers R. , et al. Pseudarthrosis after lumbar spinal fusion: the role of 18F-fluoride PET/CT. Eur J Nucl Med Mol Imaging 2015; 42 (12) 1891-1898
  • 89 Slone RM, MacMillan M, Montgomery WJ. Spinal fixation. Part 3. Complications of spinal instrumentation. Radiographics 1993; 13 (04) 797-816
  • 90 Lee MJ, Kim S, Lee SA. , et al. Overcoming artifacts from metallic orthopedic implants at high-field-strength MR imaging and multi-detector CT. Radiographics 2007; 27 (03) 791-803
  • 91 Punt IM, Austen S, Cleutjens JP. , et al. Are periprosthetic tissue reactions observed after revision of total disc replacement comparable to the reactions observed after total hip or knee revision surgery?. Spine 2012; 37 (02) 150-159
  • 92 Yang CC, Tang CL, Tzeng CY, Tsou HK. Metallosis after traumatic loosening of Bryan cervical disc arthroplasty: a case report and literature review. Eur Spine J 2018; 27 (Suppl. 03) 415-420
  • 93 Kao TH, Wu CH, Chou YC, Chen HT, Chen WH, Tsou HK. Risk factors for subsidence in anterior cervical fusion with stand-alone polyetheretherketone (PEEK) cages: a review of 82 cases and 182 levels. Arch Orthop Trauma Surg 2014; 134 (10) 1343-1351
  • 94 Kasliwal MK, Tan LA, Traynelis VC. Infection with spinal instrumentation: review of pathogenesis, diagnosis, prevention, and management. Surg Neurol Int 2013; 4 (Suppl. 05) S392-S403
  • 95 Hayashi D, Roemer FW, Mian A, Gharaibeh M, Müller B, Guermazi A. Imaging features of postoperative complications after spinal surgery and instrumentation. AJR Am J Roentgenol 2012; 199 (01) W123-9
  • 96 Cyteval C, Bourdon A. Imaging orthopedic implant infections. Diagn Interv Imaging 2012; 93 (06) 547-557
  • 97 Baber Z, Erdek MA. Failed back surgery syndrome: current perspectives. J Pain Res 2016; 9: 979-987