Download PDF
Semin Musculoskelet Radiol 2022; 26(03): 314-328
DOI: 10.1055/s-0041-1740381
Review Article

Lumbar Spine Posttherapeutic Imaging

Maxime Lacroix 
1   Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université de Paris, Paris, France
2   Department of Radiology, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université de Paris, Paris, France
,
Emmanuelle Ferrero
3   Department of Orthopaedic Surgery, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université de Paris, Paris, France
,
Robert Burns
1   Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université de Paris, Paris, France
,
Pierre Guigui
3   Department of Orthopaedic Surgery, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université de Paris, Paris, France
,
Olivier Clement
2   Department of Radiology, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université de Paris, Paris, France
,
Antoine Feydy
1   Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université de Paris, Paris, France
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Management of patients after lumbar spine surgery or interventional radiology can be complex, and postoperative imaging patterns are often poorly understood by nonspecialized radiologists. This article focuses on postoperative imaging features of the lumbar spine in five clinical settings (with corresponding interventions): vertebral osteoporotic fractures (percutaneous vertebroplasty and vertebral augmentation), lumbar disk herniation (surgical diskectomy and percutaneous interventional radiology), lumbar spinal stenosis (surgical decompression), lumbar spondylolisthesis (surgical decompression and fusion), and degenerative scoliosis (techniques of osteotomies).

For each intervention, we discuss imaging indications, depending if the patient is asymptomatic or if there are suspected complications, describe normal and pathologic imaging features, and present key points.

Keywords

vertebroplasty - spine - orthopaedic procedures - spinal fusion - diagnostic imaging


Publication History

Article published online:
02 June 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Manz D, Georgy M, Beall DP, Baroud G, Georgy BA, Muto M. Vertebral augmentation with spinal implants: third-generation vertebroplasty. Neuroradiology 2020; 62 (12) 1607-1615
    CrossrefPubMedGoogle Scholar
  • 2 Filippiadis DK, Marcia S, Masala S, Deschamps F, Kelekis A. Percutaneous vertebroplasty and kyphoplasty: current status, new developments and old controversies. Cardiovasc Intervent Radiol 2017; 40 (12) 1815-1823
    CrossrefPubMedGoogle Scholar
  • 3 Tsoumakidou G, Too CW, Koch G. et al. CIRSE guidelines on percutaneous vertebral augmentation. Cardiovasc Intervent Radiol 2017; 40 (03) 331-342
    CrossrefPubMedGoogle Scholar
  • 4 Kathuria S. Post-vertebral augmentation spine imaging. Neuroimaging Clin N Am 2014; 24 (02) 337-347
    CrossrefPubMedGoogle Scholar
  • 5 Fossaceca R, Di Terlizzi M, Stecco A. et al. MRI post-vertebroplasty. Radiol Med (Torino) 2007; 112 (02) 185-194
    CrossrefPubMedGoogle Scholar
  • 6 Tanigawa N, Komemushi A, Kariya S. et al. Relationship between cement distribution pattern and new compression fracture after percutaneous vertebroplasty. AJR Am J Roentgenol 2007; 189 (06) W348-W352
    CrossrefPubMedGoogle Scholar
  • 7 Voormolen MHJ, van Rooij WJ, van der Graaf Y. et al. Bone marrow edema in osteoporotic vertebral compression fractures after percutaneous vertebroplasty and relation with clinical outcome. AJNR Am J Neuroradiol 2006; 27 (05) 983-988
    PubMedGoogle Scholar
  • 8 Togawa D, Kovacic JJ, Bauer TW, Reinhardt MK, Brodke DS, Lieberman IH. Radiographic and histologic findings of vertebral augmentation using polymethylmethacrylate in the primate spine: percutaneous vertebroplasty versus kyphoplasty. Spine 2006; 31 (01) E4-E10
    CrossrefPubMedGoogle Scholar
  • 9 Baroud G, Swanson T, Steffen T. Setting properties of four acrylic and two calcium-phosphate cements used in vertebroplasty. J Long Term Eff Med Implants 2006; 16 (01) 51-59
    CrossrefPubMedGoogle Scholar
  • 10 Deramond H, Wright NT, Belkoff SM. Temperature elevation caused by bone cement polymerization during vertebroplasty. Bone 1999; 25 (2, Suppl): 17S-21S
    CrossrefPubMedGoogle Scholar
  • 11 Fechtenbaum J, Etcheto A, Kolta S, Feydy A, Roux C, Briot K. Sagittal balance of the spine in patients with osteoporotic vertebral fractures. Osteoporos Int 2016; 27 (02) 559-567
    CrossrefPubMedGoogle Scholar
  • 12 Roux C, Fechtenbaum J, Kolta S, Said-Nahal R, Briot K, Benhamou C-L. Prospective assessment of thoracic kyphosis in postmenopausal women with osteoporosis. J Bone Miner Res 2010; 25 (02) 362-368
    CrossrefPubMedGoogle Scholar
  • 13 Murphy KJ, Deramond H. Percutaneous vertebroplasty in benign and malignant disease. Neuroimaging Clin N Am 2000; 10 (03) 535-545
    PubMedGoogle Scholar
  • 14 Butscheidt S, Rolvien T, Ritter J. et al. Pulmonary cement embolism is not associated with the cause of death in a post-mortem cohort of cement-augmented interventions in the spine. Eur Spine J 2018; 27 (10) 2593-2601
    CrossrefPubMedGoogle Scholar
  • 15 Cotten A, Dewatre F, Cortet B. et al. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology 1996; 200 (02) 525-530
    CrossrefPubMedGoogle Scholar
  • 16 Wang LJ, Yang HL, Shi YX, Jiang WM, Chen L. Pulmonary cement embolism associated with percutaneous vertebroplasty or kyphoplasty: a systematic review. Orthop Surg 2012; 4 (03) 182-189
    CrossrefPubMedGoogle Scholar
  • 17 Georgy BA. Clinical experience with high-viscosity cements for percutaneous vertebral body augmentation: occurrence, degree, and location of cement leakage compared with kyphoplasty. AJNR Am J Neuroradiol 2010; 31 (03) 504-508
    CrossrefPubMedGoogle Scholar
  • 18 Venmans A, Klazen CAH, Lohle PNM. et al. Percutaneous vertebroplasty and pulmonary cement embolism: results from VERTOS II. AJNR Am J Neuroradiol 2010; 31 (08) 1451-1453
    CrossrefPubMedGoogle Scholar
  • 19 Venmans A, Lohle PNM, van Rooij WJ, Verhaar HJJ, Mali WP. Frequency and outcome of pulmonary polymethylmethacrylate embolism during percutaneous vertebroplasty. AJNR Am J Neuroradiol 2008; 29 (10) 1983-1985
    CrossrefPubMedGoogle Scholar
  • 20 Krueger A, Bliemel C, Zettl R, Ruchholtz S. Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: a systematic review of the literature. Eur Spine J 2009; 18 (09) 1257-1265
    CrossrefPubMedGoogle Scholar
  • 21 Trout AT, Kallmes DF, Kaufmann TJ. New fractures after vertebroplasty: adjacent fractures occur significantly sooner. AJNR Am J Neuroradiol 2006; 27 (01) 217-223
    PubMedGoogle Scholar
  • 22 Klazen CAH, Venmans A, de Vries J. et al. Percutaneous vertebroplasty is not a risk factor for new osteoporotic compression fractures: results from VERTOS II. AJNR Am J Neuroradiol 2010; 31 (08) 1447-1450
    CrossrefPubMedGoogle Scholar
  • 23 Firanescu CE, de Vries J, Lodder P. et al. Percutaneous vertebroplasty is no risk factor for new vertebral fractures and protects against further height loss (VERTOS IV). Cardiovasc Intervent Radiol 2019; 42 (07) 991-1000
    CrossrefPubMedGoogle Scholar
  • 24 Chen L-H, Hsieh M-K, Liao J-C. et al. Repeated percutaneous vertebroplasty for refracture of cemented vertebrae. Arch Orthop Trauma Surg 2011; 131 (07) 927-933
    CrossrefPubMedGoogle Scholar
  • 25 Kim ES, Oladunjoye AO, Li JA, Kim KD. Spontaneous regression of herniated lumbar discs. J Clin Neurosci 2014; 21 (06) 909-913
    CrossrefPubMedGoogle Scholar
  • 26 Amoretti N, Hauger O, Marcy P-Y. et al. Percutaneous discectomy on lumbar radiculopathy related to disk herniation: why under CT guidance? An open study of 100 consecutive patients. Eur J Radiol 2012; 81 (06) 1259-1264
    CrossrefPubMedGoogle Scholar
  • 27 Liguori A, Pandolfi M, Gurgitano M. et al. Image-guided percutaneous mechanical disc decompression for herniated discs: a technical note. Acta Biomed 2020; 91 (10-S): e2020001
    PubMedGoogle Scholar
  • 28 Amoretti N, Huwart L, Marcy P-Y, Foti P, Hauger O, Boileau P. CT- and fluoroscopy-guided percutaneous discectomy for lumbar radiculopathy related to disc herniation: a comparative prospective study comparing lateral to medial herniated discs. Skeletal Radiol 2013; 42 (01) 49-53
    CrossrefPubMedGoogle Scholar
  • 29 Splendiani A, D'Orazio F, Patriarca L. et al. Imaging of post-operative spine in intervertebral disc pathology. Musculoskelet Surg 2017; 101 (Suppl. 01) 75-84
    CrossrefPubMedGoogle Scholar
  • 30 Babar S, Saifuddin A. MRI of the post-discectomy lumbar spine. Clin Radiol 2002; 57 (11) 969-981
    CrossrefPubMedGoogle Scholar
  • 31 Dina TS, Boden SD, Davis DO. Lumbar spine after surgery for herniated disk: imaging findings in the early postoperative period. AJR Am J Roentgenol 1995; 164 (03) 665-671
    CrossrefPubMedGoogle Scholar
  • 32 Annertz M, Jönsson B, Strömqvist B, Holtås S. Serial MRI in the early postoperative period after lumbar discectomy. Neuroradiology 1995; 37 (03) 177-182
    CrossrefPubMedGoogle Scholar
  • 33 Muramatsu K, Hachiya Y, Morita C. Postoperative magnetic resonance imaging of lumbar disc herniation: comparison of microendoscopic discectomy and Love's method. Spine 2001; 26 (14) 1599-1605
    CrossrefPubMedGoogle Scholar
  • 34 Grane P, Josephsson A, Seferlis A, Tullberg T. Septic and aseptic post-operative discitis in the lumbar spine—evaluation by MR imaging. Acta Radiol 1998; 39 (02) 108-115
    CrossrefPubMedGoogle Scholar
  • 35 Takahashi Y, Sato T, Hyodo H. et al. Incidental durotomy during lumbar spine surgery: risk factors and anatomic locations: clinical article. J Neurosurg Spine 2013; 18 (02) 165-169
    CrossrefPubMedGoogle Scholar
  • 36 Paez D, Sathekge MM, Douis H. et al. Comparison of MRI, [18F]FDG PET/CT, and 99mTc-UBI 29-41 scintigraphy for postoperative spondylodiscitis—a prospective multicenter study. Eur J Nucl Med Mol Imaging 2021; 48 (06) 1864-1875
    CrossrefPubMedGoogle Scholar
  • 37 Sen KK, Batish VK, Saini M. Need for precise protocol in magnetic resonance imaging of the post operative spine. Med J Armed Forces India 2002; 58 (01) 9-12
    CrossrefPubMedGoogle Scholar
  • 38 Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev 2016; (01) CD010264
    PubMedGoogle Scholar
  • 39 Schizas C, Theumann N, Burn A. et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine 2010; 35 (21) 1919-1924
    CrossrefPubMedGoogle Scholar
  • 40 Ferrero E, Guigui P. Current trends in the management of degenerative lumbar spondylolisthesis. EFORT Open Rev 2018; 3 (05) 192-199
    CrossrefPubMedGoogle Scholar
  • 41 Gille O, Challier V, Parent H. et al; French Society of Spine Surgery (SFCR). Degenerative lumbar spondylolisthesis: cohort of 670 patients, and proposal of a new classification. Orthop Traumatol Surg Res 2014; 100 (6, Suppl): S311-S315
    CrossrefPubMedGoogle Scholar
  • 42 Winegar BA, Kay MD, Chadaz TS, Taljanovic MS, Hood KA, Hunter TB. Update on imaging of spinal fixation hardware. Semin Musculoskelet Radiol 2019; 23 (02) e56-e79
    Article in Thieme ConnectPubMedGoogle Scholar
  • 43 Zeitoun R, Hussein M. Approach to interpret images produced by new generations of multidetector CT scanners in post-operative spine. Br J Radiol 2017; 90 (1079): 20170082
    CrossrefPubMedGoogle Scholar
  • 44 Hamid S, Nasir MU, So A, Andrews G, Nicolaou S, Qamar SR. Clinical applications of dual-energy CT. Korean J Radiol 2021; 22 (06) 970-982
    CrossrefPubMedGoogle Scholar
  • 45 Guggenberger R, Winklhofer S, Osterhoff G. et al. Metallic artefact reduction with monoenergetic dual-energy CT: systematic ex vivo evaluation of posterior spinal fusion implants from various vendors and different spine levels. Eur Radiol 2012; 22 (11) 2357-2364
    CrossrefPubMedGoogle Scholar
  • 46 Srinivasan A, Hoeffner E, Ibrahim M, Shah GV, LaMarca F, Mukherji SK. Utility of dual-energy CT virtual keV monochromatic series for the assessment of spinal transpedicular hardware-bone interface. AJR Am J Roentgenol 2013; 201 (04) 878-883
    CrossrefPubMedGoogle Scholar
  • 47 Ariyanayagam T, Malcolm PN, Toms AP. Advances in metal artifact reduction techniques for periprosthetic soft tissue imaging. Semin Musculoskelet Radiol 2015; 19 (04) 328-334
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Williams AL, Gornet MF, Burkus JK. CT evaluation of lumbar interbody fusion: current concepts. AJNR Am J Neuroradiol 2005; 26 (08) 2057-2066
    PubMedGoogle Scholar
  • 49 Byvaltsev VA, Kalinin AA, Giers MB, Shepelev VV, Pestryakov YY, Biryuchkov MY. Comparison of MRI visualization following minimally invasive and open TLIF: a retrospective single-center study. Diagnostics (Basel) 2021; 11 (05) 906
    CrossrefPubMedGoogle Scholar
  • 50 Ghodasara N, Yi PH, Clark K, Fishman EK, Farshad M, Fritz J. Postoperative spinal CT: what the radiologist needs to know. Radiographics 2019; 39 (06) 1840-1861
    CrossrefPubMedGoogle Scholar
  • 51 Hauger O, Obeid I, Pelé E. Imagerie du rachis arthrodésé. J Radiol 2010; 91 (9 Pt 2): 1035-1048
    CrossrefPubMedGoogle Scholar
  • 52 Ray CD. Threaded fusion cages for lumbar interbody fusions. An economic comparison with 360° fusions. Spine 1997; 22 (06) 681-685
    CrossrefPubMedGoogle Scholar
  • 53 Proietti L, Perna A, Ricciardi L. et al. Radiological evaluation of fusion patterns after lateral lumbar interbody fusion: institutional case series. Radiol Med (Torino) 2021; 126 (02) 250-257
    CrossrefPubMedGoogle Scholar