Download PDF
Semin Musculoskelet Radiol 2011; 15(2): 151-162
DOI: 10.1055/s-0031-1275598
© Thieme Medical Publishers

Plain Radiograph Assessment of Spinal Hardware

Vicnays Venu1 , 3 , Alexandra Talia Vertinsky1 , 3 , David Malfair4 , Jason B. Chew1 , 3 , Jason Shewchuk1 , 3 , Manraj K.S. Heran1 , 3 , Douglas A. Graeb1 , 3 , John T. Street2
  • 1Division of Neuroradiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
  • 2Division of Spine Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
  • 3University of British Columbia, Vancouver, British Columbia, Canada
  • 4Department of Radiology, Central Alberta Medical Imaging Services, Red Deer, Alberta, Canada
Further Information

Publication History

Publication Date:
15 April 2011 (online)

Also available at
    Permissions and Reprints

ABSTRACT

The frequency and variety of spinal instrumentation has increased tremendously over the past 100 years, and imaging plays an important role in evaluating the postoperative spine. Although assessment of spinal hardware often involves a multimodality approach, plain radiographs are the most commonly used modality, given accessibility, cost, relatively low radiation dose compared with computed tomography, and provision of positional information. An approach to assessment of plain radiographs of the postoperative spine is discussed, and examples of common postoperative complications are provided, including infection, hardware failure, incomplete fusion, and junctional failure.

KEYWORDS

Radiographs - spine surgery - complications - radiology

REFERENCES

  • 1 Berquist T H. Imaging of the postoperative spine.  Radiol Clin North Am. 2006;  44 (3) 407-418
    CrossrefPubMedGoogle Scholar
  • 2 Lonstein J E, Denis F, Perra J H, Pinto M R, Smith M D, Winter R B. Complications associated with pedicle screws.  J Bone Joint Surg Am. 1999;  81 (11) 1519-1528
    PubMedGoogle Scholar
  • 3 Slone R M, MacMillan M, Montgomery W J. Spinal fixation. Part 3. Complications of spinal instrumentation.  Radiographics. 1993;  13 (4) 797-816
    PubMedGoogle Scholar
  • 4 Slone R M, MacMillan M, Montgomery W J, Heare M. Spinal fixation. Part 2. Fixation techniques and hardware for the thoracic and lumbosacral spine.  Radiographics. 1993;  13 (3) 521-543
    PubMedGoogle Scholar
  • 5 Foley M J, Calenoff L, Hendrix R W, Schafer M F. Thoracic and lumbar spine fusion: postoperative radiologic evaluation.  AJR Am J Roentgenol. 1983;  141 (2) 373-380
    PubMedGoogle Scholar
  • 6 Mettler Jr F A, Huda W, Yoshizumi T T, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog.  Radiology. 2008;  248 (1) 254-263
    CrossrefPubMedGoogle Scholar
  • 7 Young P M, Berquist T H, Bancroft L W, Peterson J J. Complications of spinal instrumentation.  Radiographics. 2007;  27 (3) 775-789
    CrossrefPubMedGoogle Scholar
  • 8 Heary R F, Kumar S, Bono C M. Decision making in adult deformity.  Neurosurgery. 2008;  63 (3, Suppl) 69-77
    CrossrefPubMedGoogle Scholar
  • 9 Kuntz IV C, Shaffrey C I, Ondra S L et al.. Spinal deformity: a new classification derived from neutral upright spinal alignment measurements in asymptomatic juvenile, adolescent, adult, and geriatric individuals.  Neurosurgery. 2008;  63 (3, Suppl) 25-39
    PubMedGoogle Scholar
  • 10 Glassman S D, Berven S, Bridwell K, Horton W, Dimar J R. Correlation of radiographic parameters and clinical symptoms in adult scoliosis.  Spine (Phila Pa 1976). 2005;  30 (6) 682-688
    CrossrefPubMedGoogle Scholar
  • 11 Bernhardt M, Bridwell K H. Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction.  Spine (Phila Pa 1976). 1989;  14 (7) 717-721
    CrossrefPubMedGoogle Scholar
  • 12 Kim P E, Zee C S. Imaging of the postoperative spine: cages, prostheses, and instrumentation.  Spinal Imaging Med Radiol. 2007;  6 397-413
    PubMedGoogle Scholar
  • 13 Fan Y F, Chong V F, Tan S K. Failed back surgery syndrome: differentiating epidural fibrosis and recurrent disc prolapse with Gd-DTPA enhanced MRI.  Singapore Med J. 1995;  36 (2) 153-156
    PubMedGoogle Scholar
  • 14 Long D M. Failed back surgery syndrome.  Neurosurg Clin N Am. 1991;  2 (4) 899-919
    PubMedGoogle Scholar
  • 15 Richards B S. Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis.  J Bone Joint Surg Am. 1995;  77 (4) 524-529
    PubMedGoogle Scholar
  • 16 Olsen M A, Nepple J J, Riew K D et al.. Risk factors for surgical site infection following orthopaedic spinal operations.  J Bone Joint Surg Am. 2008;  90 (1) 62-69
    Google Scholar
  • 17 Fang A, Hu S S, Endres N, Bradford D S. Risk factors for infection after spinal surgery.  Spine (Phila Pa 1976). 2005;  30 (12) 1460-1465
    CrossrefPubMedGoogle Scholar
  • 18 Bose B. Delayed infection after instrumented spine surgery: case reports and review of the literature.  Spine J. 2003;  3 (5) 394-399
    CrossrefPubMedGoogle Scholar
  • 19 Guidera K J, Hooten J, Weatherly W et al.. Cotrel-Dubousset instrumentation. Results in 52 patients.  Spine (Phila Pa 1976). 1993;  18 (4) 427-431
    PubMedGoogle Scholar
  • 20 Heller J G, Whitecloud T S, Butler J C et al.. Complications of spinal surgery. In: Rothman R R, Simeone F A, eds. The Spine. 3rd ed. Philadelphia, PA: Saunders; 1992: 1817-1898
    Google Scholar
  • 21 Rutherford E E, Tarplett L J, Davies E M, Harley J M, King L J. Lumbar spine fusion and stabilization: hardware, techniques, and imaging appearances.  Radiographics. 2007;  27 (6) 1737-1749
    CrossrefPubMedGoogle Scholar
  • 22 Tehranzadeh J, Ton J D, Rosen C D. Advances in spinal fusion.  Semin Ultrasound CT MR. 2005;  26 (2) 103-113
    CrossrefPubMedGoogle Scholar
  • 23 Cahill K S, Chi J H, Day A, Claus E B. Prevalence, complications, and hospital charges associated with use of bone-morphogenetic proteins in spinal fusion procedures.  JAMA. 2009;  302 (1) 58-66
    CrossrefPubMedGoogle Scholar
  • 24 Licina P. Early complications associated with BMP in lumbar interbody fusions.  J Bone Joint Surg Br. 2009;  91-B 437-439
    PubMedGoogle Scholar
  • 25 McClellan J W, Mulconrey D S, Forbes R J, Fullmer N. Vertebral bone resorption after transforaminal lumbar interbody fusion with bone morphogenetic protein (rhBMP-2).  J Spinal Disord Tech. 2006;  19 (7) 483-486
    CrossrefPubMedGoogle Scholar
  • 26 Yazici M, Asher M A, Hardacker J W. The safety and efficacy of Isola-Galveston instrumentation and arthrodesis in the treatment of neuromuscular spinal deformities.  J Bone Joint Surg Am. 2000;  82 (4, 82-A) 524-543
    PubMedGoogle Scholar
  • 27 Suda K, Ito M, Abumi K, Haba H, Taneichi H, Kaneda K. Radiological risk factors of pseudoarthrosis and/or instrument breakage after PLF with the pedicle screw system in isthmic spondylolisthesis.  J Spinal Disord Tech. 2006;  19 (8) 541-546
    CrossrefPubMedGoogle Scholar
  • 28 Emami A, Deviren V, Berven S, Smith J A, Hu S S, Bradford D S. Outcome and complications of long fusions to the sacrum in adult spine deformity: Luque-Galveston, combined iliac and sacral screws, and sacral fixation.  Spine (Phila Pa 1976). 2002;  27 (7) 776-786
    CrossrefPubMedGoogle Scholar
  • 28a Ray C D. Threaded fusion cages for lumbar interbody fusions: an economic comparison with 360 degrees fusions.  Spine. 1997;  22 681-685
    CrossrefPubMedGoogle Scholar
  • 29 Cho K J, Suk S I, Park S R et al.. Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis.  Spine (Phila Pa 1976). 2007;  32 (20) 2232-2237
    CrossrefPubMedGoogle Scholar
  • 30 Etebar S, Cahill D W. Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability.  J Neurosurg. 1999;  90 (2, Suppl) 163-169
    CrossrefPubMedGoogle Scholar
  • 31 Schlegel J D, Smith J A, Schleusener R L. Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions.  Spine (Phila Pa 1976). 1996;  21 (8) 970-981
    CrossrefPubMedGoogle Scholar
  • 32 Lee C K, Langrana N A. Lumbosacral spinal fusion. A biomechanical study.  Spine (Phila Pa 1976). 1984;  9 (6) 574-581
    CrossrefPubMedGoogle Scholar
  • 33 Yang S W, Langrana N A, Lee C K. Biomechanics of lumbosacral spinal fusion in combined compression-torsion loads.  Spine (Phila Pa 1976). 1986;  11 (9) 937-941
    CrossrefPubMedGoogle Scholar
  • 34 Froning E C, Frohman B. Motion of the lumbosacral spine after laminectomy and spine fusion. Correlation of motion with the result.  J Bone Joint Surg Am. 1968;  50 (5) 897-918
    PubMedGoogle Scholar
  • 35 Ha K Y, Schendel M J, Lewis J L, Ogilvie J W. Effect of immobilization and configuration on lumbar adjacent-segment biomechanics.  J Spinal Disord. 1993;  6 (2) 99-105
    PubMedGoogle Scholar
  • 36 Carpenter C T, Dietz J W, Leung K Y, Hanscom D A, Wagner T A. Repair of a pseudarthrosis of the lumbar spine. A functional outcome study.  J Bone Joint Surg Am. 1996;  78 (5) 712-720
    CrossrefPubMedGoogle Scholar

Alexandra Talia VertinskyM.D. 

Division of Neuroradiology, Vancouver General Hospital

855 West 12th Ave., Vancouver, BC V5Z 1M9 Canada

Email: tvertinsky@gmail.com

      >