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Herniated Lumbar Disk Diskectomy and Stabilization
Pathological Fibrous Scar
Achille Marotta, Raffaele Nappi, Anna Caliendo,
Carmen Castagnolo and Ferdinando Caranci
• Patient with persisting left low back pain and absence of achilles reflex
following L5–S1 diskectomy with positioning of cage and L4–S1
posterior stabilization through metallic trans-peduncular screws
• Early and late XR/CT/MR postoperative follow-up (6, 9 and 12 months)
Early Postoperative Follow-Up
Fig. 1 a–b. Lumbosacral
XR: posteroanterior
(a) and lateral (b) views.
L5–S1 diskectomy,
intervertebral cage, and
L4-S1 posterior
stabilization
Case
17
F. Caranci (&)
Advanced Biomedical Sciences Department, Unit of Neuroradiology, ‘‘Federico II’’ University, Naples, Italy
e-mail: ferdinandocaranci@libero.it
A. Marotta R. Nappi A. Caliendo C. Castagnolo
Unit of Diagnostic Imaging, Villa Fiorita Clinic, Capua, CE, Italy
T. Scarabino and S. Pollice (eds.), Imaging Spine After Treatment,
DOI: 10.1007/978-88-470-5391-5_22, Springer-Verlag Italia 2014
79
80 A. Marotta et al.
Fig. 2 a–b. Lumbosacral dynamic XR: lateral views in hyperflexion (a) and in hyperextension (b). No evidence of
instability, preserved alignment of posterior vertebral profile
Postoperative Follow-Up After 6 Months
Fig. 3 a–m. MPR sagittal (a–e) and axial sections at L4–L5 (f–i) and L5-S1 (j–m). Post-surgery inhomogeneity of
retrovertebral space due to the presence of fibrotic tissue (a–e). Axial images at L4–L5 (f–i) document angulation of
right pin with respect to its screw (arrow); axial images at L5-S1 (j–m) document the cause of low back pain due to
left S1 root surrounded by fibrous scar (arrowheads)
Case 17 - Herniated Lumbar Disk. Diskectomy and Stabilization 81
Postoperative Follow-Up After 9 Months
Fig. 4 a–g. FSE T2 sagittal (a–c) and axial sections (d–g). Presence of intermediate signal fibrous-like tissue
occupying left epidural space at L5-S1, with indissociability of S1 root
82 A. Marotta et al.
Postoperative Follow-Up After 12 Months
Fig. 5 a–q. CT and CE CT (a–h), coronal (i–l) and sagittal MPR sections (m–q). Fibrous scar at L5-S1 (a–d) with
mild CE (e–h); coronal MPR sections (i–l) confirm obliteration of left epidural space (arrow), with indissociability of
S1 root. Sagittal MPR sections (m–q) show slight reduction in height and calcification of L5-S1 intervertebral space
Herniated Lumbar Disk Diskectomy and Stabilization
Septic Spondylodiscitis
Chiara Potente, Roberto Trignani, Tommaso Scarabino
and Gabriele Polonara
• Patient with recurrent low back pain after left hemi-lamino-flavectomy,
L5–S1 diskectomy and dynamic vertebral stabilization with posterior
metallic flexible bars and transpedicular screws at L4, L5 and S1
• Early and late CT-MR postoperative follow-up (after removal of bars
and screws)
Early Postoperative Follow-Up
Case
18
Fig. 1 a–c. Bone CT axial
(a) MPR sagittal (b), and
coronal (c). Postsurgery
bone resorption
surrounding screws:
expecially right S1 (arrow)
C. Potente G. Polonara (&)
Department of Neuroradiology, University Hospital, Ancona, Italy
e-mail: g.polonara@univpm.it
T. Scarabino
Department of Radiology—Neuroradiology, ‘‘Lorenzo Bonomo’’ Hospital, Andria, Italy
R. Trignani
Department of Neurosurgery, University Hospital, Ancona, Italy
T. Scarabino and S. Pollice (eds.), Imaging Spine After Treatment,
DOI: 10.1007/978-88-470-5391-5_23, Springer-Verlag Italia 2014
(a)
(b)
(c)
83
84 C. Potente et al.
Late Postoperative Follow-Up
Fig. 2 a–c. SE T1 sagittal (a) FSE fat sat T2 sagittal (b), and axial (c). L5–S1 signal alteration in flogosis that extend
to epidural space. Narrowing of dural sac. Flogosis develops in lateral-rear-left space, site of previous hemilaminectomy
Case 18 - Herniated Lumbar Disk. Diskectomy and Stabilization 85
Fig. 3 a–e. CE fat sat T1 sagittal (a, b), coronal (c) and axial (d, e). Intensive CE of flogosis tissue with lateral-left
liquid collection that extend posteriorly in soft tissue surrounding spine. Inhomogeneous CE of vertebral bodies and
surrounding soft tissue
Herniated Lumbar Disk Diskectomy and Stabilization
Spondylodiscitis-Radiculitis
Chiara Potente, Roberto Trignani, Tommaso Scarabino
and Gabriele Polonara
• Patient with recurrent low back pain after percutaneous hybrid
rear stabilization by transpeduncular screws and bars (strict
component on L5–S1 and flexible on L3–L4 and L4–L5)
• Late MR postoperative follow-up
Late Postoperative Follow-Up
Fig. 1 a–d.SET1(a),
FSE T2 (b), STIR sagittal
(c) and FSE axial (d).
Signal alteration of L2–L3
disk and vertebral bodies in
spondylodiscitis with
subchondral involvement
(a-c) especially in the
central inferior region of
L2 and superior of L3.
L2–L3 disk herniates
posteriorly (a-
d) compressing dural sac in
right paramedian with root
conflict
Case
19
C. Potente G. Polonara (&)
Department of Neuroradiology, University Hospital, Ancona, Italy
e-mail: g.polonara@univpm.it
T. Scarabino
Department of Radiology—Neuroradiology, ‘‘Lorenzo Bonomo’’ Hospital, Andria, Italy
R. Trignani
Department of Neurosurgery, University Hospital, Ancona, Italy
T. Scarabino and S. Pollice (eds.), Imaging Spine After Treatment,
DOI: 10.1007/978-88-470-5391-5_24, Springer-Verlag Italia 2014
87
88 C. Potente et al.
Fig. 1 (continued)
Fig. 2 a–c. SE T1 sagittal
(a), and SE fat-sat T1 axial
(b, c). Homogeneous CE of
the herniated fragment (a).
In L2–L3 epidural
collection with slight
bilateral intraforaminal
expansion (a, b); CE of
surrounding soft tissue
probably involved by
flogosis (b, c). CE of nerve
root in radiculitis
(a-c, arrows)
(a)
(b) (c)
Herniated Lumbar Disk Intradiskal Percutaneous Procedure
Septic Spondylodiscitis
Mario Muto, Gianluigi Guarnieri and Roberto Izzo
Preoperative Imaging
Case
20
• Patient with incremented low back pain, fever, ESR and PCR high
levels after percutaneous L4–L5 intra-discal treatment through left
posterolateral approach under CT guide
• Preoperative imaging and early and late MR postoperative follow-up
(10 days and 3 weeks)
Fig. 1 FSE T2 sagittal.
L4–L5 and L5-S1 left
posterolateral hernia
M. Muto (&) G. Guarnieri R. Izzo
Department of Neuroradiology, ‘‘Cardarelli’’ Hospital, Naples, Italy
e-mail: mutomar@tiscali.it
T. Scarabino and S. Pollice (eds.), Imaging Spine After Treatment,
DOI: 10.1007/978-88-470-5391-5_25, Springer-Verlag Italia 2014
89