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Post Surgical Spinal Evaluation

J. Randy Jinkins¹, David D. Stark¹

¹Downstate Medical Center, State University of New York, Brooklyn, New York

Publication Name:

Current Protocols in Magnetic Resonance Imaging

Unit Number:

Unit A8.8

DOI:

10.1002/0471142719.mia0808s08

Online Posting Date:

May, 2003

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Abstract

One of the most challenging areas of diagnosis is to be found in acquiring and interpreting medical images in the patient who has undergone lumbosacral surgery for spinal degenerative disease. The section illustrates the features of expected and abnormal postsurgical spinal imaging. These discussions provide the background, practical information, and graphic examples necessary to enable the medical imaging physician to better approach the clinicoradiologic evaluation of the postsurgical patient.

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Unit Introduction
Basic Protocol: Conventional and Fast Spin Echo Acquisitions
Alternate Protocol: Coronal Contrast Enhances Acquisition
Commentary
Literature Cited
Figures
Tables

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Materials

Basic Protocol: Conventional and Fast Spin Echo Acquisitions

Materials

Normal saline (0.9% NaCl) sterile
Extravascular contrast agent (e.g., Mangevist, Omniscan, or Prohance)

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Figures

Figure A8.8.1

Postoperative chronic adhesive arachnoiditis. (A) Sagittal T₂-weighted (T_R = 4000 msec, T_E = 100 msec) fat suppressed image shows matting of the nerve roots superiorly (arrows) and are “empty thecal sac” inferiorly (asterisk) indicating adhesive fibrosis of the contents of the thecal sac. (B) Transverse T₂-weighted (T_R = 4000 msec,T_E = 100 msec) image at L5 shows again the “empty thecal sac” (asterisk) in this region due to adhesion of the intrathecal nerve roots to the peripheral walls of the thecal sac.

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Figure A8.8.2

Postoperative recurrent disc herniation. (A) Transverse T₁-weighted (T_R = 500 msec, T_E = 10 msec) image shows mildly hyperintense mass (arrow) at L4-5 on the right side of the spinal canal anteriorly. (B) i.v. gadolinium enhanced T₁-weighted (T_R= 500 msec, T_E = 10 msec) image shows rim enhancement surrounding a recurrent disc herniation (arrow).

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Literature Cited

Literature Cited
	Ghazi, J., Golimbu, C.N., and Engler, G.L. 1992. MRI of spinal fusion pseudoarthrosis. J. Comput. Assist. Tomogr. 16:324-326.
	Grane, P., Josephsson, A., Seferlis, A., and Tullberg, T. 1998. Septic and aseptic post-operative discitis in the lumbar spine—evaluation by MR imaging. Acta Radiol. 39:108-115.
	Jinkins, J.R. 1993. Magnetic resonance imaging of benign nerve root enhancement in the unoperated and postoperative lumbosacral spine. Neuroimaging Clin. North Am. 3:525-541.
	Jinkins, J.R., Osborn, A.G., Garrett, D. Jr., and Hunt, S. 1993. Spinal nerve enhancement with Gd-DTPA: MR correlation with the postoperative lumbosacral spine. Am. J. Neuroradiol. 14:383-394.
	Shafaiae, F., Bunscuh, C., and Jinkins, J.R. 1997. The posttherapeutic lumbosacral spine. In Posttherapeutic Neurodiagnostic Imaging (J.R. Jinkins, ed.) pp. 223-243. Lippincott-Raven, Philadelphia.
	Shellock, F.G. 1996. Pocket Guide to MR Procedures and Metallic Objects. Lippincott-Raven, Philadelphia.
	Van Goethem, J.W., Parizel, P.M., van den Hauwe, L., and DeSchepper, A.M. 1997. Imaging findings in patients with failed back surgery syndrome. J. Belge Radiol. 80(2):81-84.