DOI QR코드

DOI QR Code

Imaging Evaluation of Early and Long-Term Complications Associated with the Postoperative Spine

척추 수술 후 영상 평가: 초기 및 중장기 합병증

  • Jae Hwi Park (Department of Radiology, SMG-SNU Boramae Medical Center) ;
  • Dong Hyun Kim (Department of Radiology, SMG-SNU Boramae Medical Center) ;
  • Jee Won Chai (Department of Radiology, SMG-SNU Boramae Medical Center) ;
  • Hyo Jin Kim (Department of Radiology, SMG-SNU Boramae Medical Center) ;
  • Jiwoon Seo (Department of Radiology, SMG-SNU Boramae Medical Center) ;
  • Jin Young Son (Department of Radiology, SMG-SNU Boramae Medical Center)
  • 박재휘 (서울특별시보라매병원 영상의학과) ;
  • 김동현 (서울특별시보라매병원 영상의학과) ;
  • 채지원 (서울특별시보라매병원 영상의학과) ;
  • 김효진 (서울특별시보라매병원 영상의학과) ;
  • 서지운 (서울특별시보라매병원 영상의학과) ;
  • 손진영 (서울특별시보라매병원 영상의학과)
  • Received : 2023.12.03
  • Accepted : 2024.01.14
  • Published : 2024.01.01

Abstract

As the number of spinal surgeries being performed expands, the number of medical imaging procedures such as radiography, CT, and MRI is also increasing, and the importance of their interpretation is becoming more significant. Herein, we present the radiological findings of a variety of complications that can occur after spinal surgery and discuss how effectively and accurately they can be diagnosed through imaging. In particular, this study details the characteristic imaging findings specific to the early and long-term postoperative periods. Early complications of spinal surgery include improper placement of surgical instruments (instrument malpositioning), seromas, hematomas, pseudomeningoceles, and infections in the region surrounding the surgical site. Conversely, long-term complications may include osteolysis around surgical instruments, failure of fusion, adjacent segment disease, and the formation of epidural fibrosis or scar tissue. A precise understanding of the imaging assessments related to complications arising after spinal surgery is crucial to ensure timely and accurate diagnosis, which is necessary to achieve effective treatment.

척추 수술의 빈도 증가와 더불어 radiography, CT, MRI 등의 의료 영상 촬영 건수도 증가하고 있으며, 이와 관련된 영상 판독의 중요성이 점점 더 커지고 있다. 본 논문에서는 척추 수술 후 발생 가능한 다양한 합병증을 이해하고, 이를 정확하고 효과적으로 진단하는 영상 검사의 중요 소견에 대해 다루고자 한다. 특히, 수술 후 초기 및 중장기 합병증을 구분하여, 각 시기별 특징적인 영상 소견을 자세히 설명한다. 척추 수술 후 초기 합병증으로는 부적절한 수술 기구 배치(instrument malposition), 장액종(seroma), 혈종(hematoma), 거짓수막류(pseudomeningocele), 수술 주변 감염(infection) 등이 있으며, 중장기 합병증으로는 수술 기구 주변의 골용해(osteolysis), 융합 실패(failure of fusion), 인접 분절 질환(adjacent segment disease), 경막외 섬유화 또는 흉터 조직(epidural fibrosis or scar) 형성 등이 포함된다. 이러한 척수 수술 후 발생하는 합병증 관련 영상 평가에 대한 정확한 이해는 척추 수술 후 합병증을 적시에 정확하게 진단하여 효과적인 환자 치료에 기여할 것이다.

Keywords

References

  1. Fehlings MG, Tetreault L, Nater A, Choma T, Harrop J, Mroz T, et al. The aging of the global population: the changing epidemiology of disease and spinal disorders. Neurosurgery 2015;77 Suppl 4:S1-S5  https://doi.org/10.1227/NEU.0000000000000953
  2. Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS. Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. Spine (Phila Pa 1976) 2019;44:369-376  https://doi.org/10.1097/BRS.0000000000002822
  3. Abel F, Tan ET, Chazen JL, Lebl DR, Sneag DB. MRI after lumbar spine decompression and fusion surgery: technical considerations, expected findings, and complications. Radiology 2023;308:e222732 
  4. Hayashi D, Roemer FW, Mian A, Gharaibeh M, Muller B, Guermazi A. Imaging features of postoperative complications after spinal surgery and instrumentation. AJR Am J Roentgenol 2012;199:W123-W129  https://doi.org/10.2214/AJR.11.6497
  5. Ghodasara N, Yi PH, Clark K, Fishman EK, Farshad M, Fritz J. Postoperative spinal CT: what the radiologist needs to know. Radiographics 2019;39:1840-1861  https://doi.org/10.1148/rg.2019190050
  6. Nasser R, Yadla S, Maltenfort MG, Harrop JS, Anderson DG, Vaccaro AR, et al. Complications in spine surgery. J Neurosurg Spine 2010;13:144-157  https://doi.org/10.3171/2010.3.SPINE09369
  7. Ortiz AO, de Moura A, Johnson BA. Postsurgical spine: techniques, expected imaging findings, and complications. Semin Ultrasound CT MR 2018;39:630-650  https://doi.org/10.1053/j.sult.2018.10.017
  8. Herrera Herrera I, Moreno de la Presa R, Gonzalez Gutierrez R, Barcena Ruiz E, Garcia Benassi JM. Evaluation of the postoperative lumbar spine. Radiologia 2013;55:12-23  https://doi.org/10.1016/j.rx.2011.12.004
  9. Bittane RM, de Moura AB, Lien RJ. The postoperative spine: what the spine surgeon needs to know. Neuroimaging Clin N Am 2014;24:295-303  https://doi.org/10.1016/j.nic.2014.01.006
  10. Girao MMV, Miyahara LK, Dwan VSY, Baptista E, Taneja AK, Gotfryd A, et al. Imaging features of the postoperative spine: a guide to basic understanding of spine surgical procedures. Insights Imaging 2023;14:103 
  11. Rutherford EE, Tarplett LJ, Davies EM, Harley JM, King LJ. Lumbar spine fusion and stabilization: hardware, techniques, and imaging appearances. Radiographics 2007;27:1737-1749  https://doi.org/10.1148/rg.276065205
  12. Goodwin ML, Buchowski JM, Sciubba DM. Why X-rays? The importance of radiographs in spine surgery. Spine J 2022;22:1759-1767  https://doi.org/10.1016/j.spinee.2022.07.102
  13. Khodarahmi I, Fishman EK, Fritz J. Dedicated CT and MRI techniques for the evaluation of the postoperative knee. Semin Musculoskelet Radiol 2018;22:444-456  https://doi.org/10.1055/s-0038-1653955
  14. Scarabino T, Giannatempo GM, Pollice S, Nasuto M, Balzano RF, Popolizio T. 3.0 T MRI diagnostic features: comparison with lower magnetic fields. In Scarabino T, Pollice S, Popolizio T, eds. High field brain MRI. Cham: Springer 2017:13-25 
  15. Jungmann PM, Agten CA, Pfirrmann CW, Sutter R. Advances in MRI around metal. J Magn Reson Imaging 2017;46:972-991  https://doi.org/10.1002/jmri.25708
  16. Ulbrich EJ, Sutter R, Aguiar RF, Nittka M, Pfirrmann CW. STIR sequence with increased receiver bandwidth of the inversion pulse for reduction of metallic artifacts. AJR Am J Roentgenol 2012;199:W735-W742  https://doi.org/10.2214/AJR.11.8233
  17. Splendiani A, D'Orazio F, Patriarca L, Arrigoni F, Caranci F, Fonio P, et al. Imaging of post-operative spine in intervertebral disc pathology. Musculoskelet Surg 2017;101(Suppl 1):75-84  https://doi.org/10.1007/s12306-017-0453-4
  18. Petscavage-Thomas JM, Ha AS. Imaging current spine hardware: part 1, cervical spine and fracture fixation. AJR Am J Roentgenol 2014;203:394-405  https://doi.org/10.2214/AJR.13.12216
  19. Young PM, Berquist TH, Bancroft LW, Peterson JJ. Complications of spinal instrumentation. Radiographics 2007;27:775-789  https://doi.org/10.1148/rg.273065055
  20. Zampolin R, Erdfarb A, Miller T. Imaging of lumbar spine fusion. Neuroimaging Clin N Am 2014;24:269-286  https://doi.org/10.1016/j.nic.2014.01.004
  21. Lonstein JE, Denis F, Perra JH, Pinto MR, Smith MD, Winter RB. Complications associated with pedicle screws. J Bone Joint Surg Am 1999;81:1519-1528  https://doi.org/10.2106/00004623-199911000-00003
  22. Neo M, Sakamoto T, Fujibayashi S, Nakamura T. The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine (Phila Pa 1976) 2005;30:2800-2805  https://doi.org/10.1097/01.brs.0000192297.07709.5d
  23. Willson MC, Ross JS. Postoperative spine complications. Neuroimaging Clin N Am 2014;24:305-326  https://doi.org/10.1016/j.nic.2014.01.002
  24. Bellini M, Ferrara M, Grazzini I, Cerase A. Neuroimaging of the postoperative spine. Magn Reson Imaging Clin N Am 2016;24:601-620  https://doi.org/10.1016/j.mric.2016.04.006
  25. Post MJ, Becerra JL, Madsen PW, Puckett W, Quencer RM, Bunge RP, et al. Acute spinal subdural hematoma: MR and CT findings with pathologic correlates. AJNR Am J Neuroradiol 1994;15:1895-1905 
  26. Quaile A. Infections associated with spinal implants. Int Orthop 2012;36:451-456  https://doi.org/10.1007/s00264-011-1408-2
  27. Babar S, Saifuddin A. MRI of the post-discectomy lumbar spine. Clin Radiol 2002;57:969-981  https://doi.org/10.1053/crad.2002.1071
  28. Malhotra A, Kalra VB, Wu X, Grant R, Bronen RA, Abbed KM. Imaging of lumbar spinal surgery complications. Insights Imaging 2015;6:579-590  https://doi.org/10.1007/s13244-015-0435-8
  29. Ross JS, Robertson JT, Frederickson RC, Petrie JL, Obuchowski N, Modic MT, et al. Association between peridural scar and recurrent radicular pain after lumbar discectomy: magnetic resonance evaluation. Neurosurgery 1996;38:855-861; discussion 861-863 https://doi.org/10.1227/00006123-199604000-00053