What diagnostic imaging tests are useful in the evaluation of patients following prior spinal surgery

The sequence of imaging studies in the postoperative patient is similar to assessment for primary spine surgery. Imaging studies are indicated to confirm the most likely cause of symptoms based on a comprehensive history and physical examination.

• Radiographs. Upright posteroanterior (PA) and lateral spine radiographs are the initial imaging study. Lateral flexion-extension radiographs play a role in the diagnosis of postoperative instability or pseudarthrosis. Assessment of spinal deformities is best accomplished with standing 36-inch PA and lateral radiographs

• Magnetic resonance imaging (MRI), computed tomography (CT), and CT-myelography. The most appropriate study is selected based on the patient's symptoms, the presence or absence of spinal implants, and the specific spinal problem requiring assessment. MRI provides optimal visualization of the neural elements and associated bony and soft tissue structures. However, MRI is subject to degradation by metal artifact that may arise from microscopic debris remaining at the initial surgical site or from spinal implants (especially non-titanium implants). CT remains the optimal test to assess bone detail and is the preferred test for diagnosis of pseudarthrosis. CT-myelography is of great utility in evaluation of the previously operated spine. It provides excellent visualization of the thecal sac and nerve roots in addition to osseous structure even in the presence of spinal deformity or extensive metallic spinal implants

• Technetium bone scans. Although this study may provide valuable information for the diagnosis of infection and metastatic disease, it has little utility in planning revision spine procedures due to lack of spatial resolution

• Discography. May be helpful in confirming the disc as a pain generator for axial pain symptoms and can play a role in assessment of degenerative disc changes above or below a prior spinal fusion

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