The role of nuclear medicine imaging in the diagnosis and management of postoperative spinal infections in the setting of instrumentation

Pediatric spine imaging post scoliosis surgery

Many orthopedic articles describe advances in surgical techniques and implants used in pediatric scoliosis surgery. However, even though postoperative spine imaging constitutes a large portion of outpatient musculoskeletal pediatric radiology, few, if any, radiology articles discuss this topic. There has been interval advancement over the last decades of the orthopedic procedures used in the treatment of spinal scoliosis in adolescents with idiopathic scoliosis. The goal of treatment in these patients is to stop the progression of the curve by blocking the spinal growth and correcting the deformity as much as possible. To that end, the authors in this paper discuss postoperative imaging findings of Harrington rods, Luque rods, Luque-Galveston implants and segmental spinal fusion systems. Regarding early onset scoliosis, the guiding principles used for adolescent idiopathic scoliosis do not apply to a growing spine because they would impede lung development. As a result, other devices have been developed to correct the curve and to allow spinal growth. These include spine-based growing rods, vertically expandable prosthetic titanium rods (requiring repetitive surgeries) and magnetically controlled growing rods (with a magnetic locking/unlocking system). Other more recent systems are Shilla and thoracoscopic anterior vertebral body tethering, which allow guided growth of the spine without repetitive interventions. In this paper, we review the radiologic appearances of different orthopedic implants and techniques used to treat adolescent idiopathic scoliosis and early onset scoliosis. Moreover, we present the imaging findings of the most frequent postoperative complications.

Postoperative spine imaging in cancer patients

Primary or metastatic spine tumors can present with pain and/or neurologic compromise depending on their location within the spinal axis. Metastases and multiple myeloma comprise most of these lesions. Management of spinal tumors includes surgical decompression with stabilization (neo), adjuvant chemotherapy and radiation therapy, curettage, bone grafting, bone marrow replacement, and palliative treatment with vertebral augmentation. Pre- and postoperative imaging plays a critical role in the diagnosis and management of patients with spinal tumors. This article reviews postoperative imaging of the spine, including imaging protocols, immediate and long-term routine imaging findings, and emergent findings in symptomatic patients.