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Case 33 - Synovial Cysts. Surgical Removal 127
Pre-operative Imaging
Fig. 2 a–f. FSE T2 sagittal sections in supine (a–c) and orthostatic position (d–f). Moving from supine (a–c)to
orthostatic position (d–f) there is narrowing of vertebral canal at L4-L5 with incremented ‘‘impingement’’ of synovial
cyst (arrow)
128 F. Caranci et al.
Postoperative Follow-Up After 2 Months
Fig. 3 a–g. FSE T2
sagittal (a–c) and axial
sections (d–g). At L4–L5
inhomogeneity of retrovertebral muscles due to
surgery (a–c) with removal
of right yellow ligament
(d–g). Right synovial cyst
(b–e, arrow) is still present
(probably recurrence) and
communicating with interapophyseal fluid. Further
synovial cyst at L3–L4
(b, arrowhead)
Case 33 - Synovial Cysts. Surgical Removal 129
Postoperative Follow-Up After 3 Months
Fig. 4 a–g. FSE T2
sagittal (a–c) and axial
sections (d–g). Reduction
of the right L4–L5 synovial
cyst (b–e, arrow), related
with clinical improvement.
The further synovial cyst is
more evident at L3–L4 (a,
arrowhead)
Case
Instability and Lumbar Stenosis Positioning of Inter-Spinous Device
Regular Findings
Tommaso Scarabino, Saverio Pollice, Michela Capuano,
Michele Santoro and Raniero Mignini
• Instability and lumbar stenosis treated by inter-spinous devices
(X-Stop, Wallis, DIAM, Coflex, In-Space)
• Medical device and related XR imaging
34
Fig. 1 a–c. Interspinous device X-Stop. a Device. b–c XR lateral and anteroposterior. X-Stop consists of two parallel
lateral wings that prevent itself lateral migration connected by a titanium rod or spacer. During implantation, the rod is
inserted in transverse way, penetrating the interspinous ligament. It is constrained anteriorly by the lamina,
craniocaudally by the spinous processes, and posteriorly by the supraspinous ligament. The rod places the patient in
slight flexion, while limiting extension. The flexion obtained by the insertion of the device leads to stretching of
yellow ligaments and distracting of nerve foramina
T. Scarabino (&) S. Pollice M. Capuano
Department of Radiology—Neuroradiology, ‘‘Lorenzo Bonomo’’ Hospital, Andria, Italy
e-mail: tscarabino@hotmail.com
M. Santoro R. Mignini
Department of Neurosurgery, ‘‘Lorenzo Bonomo’’ Hospital, Andria, Italy
T. Scarabino and S. Pollice (eds.), Imaging Spine After Treatment,
DOI: 10.1007/978-88-470-5391-5_39, Springer-Verlag Italia 2014
131
132 T. Scarabino et al.
Fig. 2 a–b. Interspinous Wallis. a Device. b XR lateral. Wallis is polyetheretherketone (PEEK), with elastic-like
bone characteristics, stabilized with two strips of Dacron. Although it is not truly compressible, properties of material
are very close to the elastic modulus of the posterior spine. The two strips of dacron embrace the upper and lower
spinous processes, pulled with a special tool. Compared to other interspinous systems also allow to enlarge anterior
disk space
Fig. 3 a–c. Interspinous DIAM. a Device. b–c XR lateral and anteroposterior. DIAM consists of a silicon core
covered by polyester sleeve. The core and sleeve are held in the interspinous space by three mesh bands. Two of the
bands encircle the adjacent spinous processes, while a third encases the supraspinous ligament. The silicon device is
radiolucent, but radiopaque markers along the superior edge of the core allow for radiographic identification. Packed
with compressible material, is not a true stabilizer because it lacks its own stabilizing force. It maintains the rigidity of
the rear compartment of the functional unit formed by the intervertebral disk, and interapophyseal joints finding
indication when the size of the root canal should be preserved
Case 34 - Instability and Lumbar Stenosis 133
Fig. 4 a–b. Interspinous Coflex. a Device. b XR lateral. The Coflex is a U-shaped titanium implant that is placed into
the interspinous space with clips on the upper and lower margins that allow the locking. While the height of the device
distracts the foraminal opening, the ‘‘U’’ shape is designed to allow controlled movement in forward and backward
bending. Implantation of this device is more invasive than others, involving resection of both interspinous and
supraspinous ligaments
Fig. 5 a–b. Interspinous In-Space. a Device. b XR lateral. In-Space consists of PEEK radiolucent body and titanium
alloy (TAV) screw and wings to allow radiographic assessment of the correct installation. Turning the screw, the
implant closes and the wings are deployed along the spinous processes. The wings prevent ventral and lateral
migration of the implant while the intact supraspinous ligament prevents dorsal displacement. The percutaneous lateral
approach not allow stripping of the paraspinal muscles. Moreover supraspinous ligament is left intact, interspinous
ligament is only pierced to the size of the implant, no bone needs to be removed to facilitate the insertion of the
implant
Degenerative Lumbar Instability Double Interspinous Device Positioning
Regular Findings
Tommaso Scarabino, Michele Maiorano, Tullia Garribba,
Giuseppe Diaferia and Michele Santoro
• Patient with low back pain due to vertebral instability treated by
double interspinous device (DIAM) at L4–L5 and L5–S1.
• XR/MR postoperative follow-up.
Postoperative Follow-up
Fig. 1 a–d.XR
anteroposterior (a) and
lateral (b) Dynamic
acquisition in max
extension (c) and max
flexion (d). Positioning of
double interspinous device
at L4-L5 e L5-S1 (little
radio-opacity of the device
is appreciable). Slight left
lumbar scoliosis. Slight
anterior listhesis L5–S1 not
changing in dynamic
acquisition
Case
35
T. Scarabino (&) M. Maiorano T. Garribba
Department of Radiology—Neuroradiology, ‘‘Lorenzo Bonomo’’ Hospital, Andria, Italy
e-mail: tscarabino@hotmail.com
G. Diaferia M. Santoro
Department of Neurosurgery, ‘‘Lorenzo Bonomo’’ Hospital, Andria, Italy
T. Scarabino and S. Pollice (eds.), Imaging Spine After Treatment,
DOI: 10.1007/978-88-470-5391-5_40, Springer-Verlag Italia 2014
135
136 T. Scarabino et al.
Fig. 1 (continued)
Fig. 2 a–c.SET1(a),
FSE T2 sagittal (b), SE T1
axial (c). Normal
positioning of device
(low signal)
Lumbar Degenerative Instability Interspinous Device Positioning
Regular Findings
Paola D’Aprile and Alfredo Tarantino
Preoperative Imaging
Fig. 1 a–b.SET1(a) and
fat sat FSE T2 (b). L4–L5
disk height reduction and
dehydration with reduction
of amplitude of the
interspinous space
Case
36
• Patient with low back pain in vertebral instability due to L4–L5 diskal
degeneration treated by interspinous device
• MR preoperative imaging and post-operative follow-up
P. D’Aprile (&) A. Tarantino
Department of Neuroradiology, ‘‘San Paolo’’ Hospital, Bari, Italy
e-mail: paoladaprile@yahoo.it
T. Scarabino and S. Pollice (eds.), Imaging Spine After Treatment,
DOI: 10.1007/978-88-470-5391-5_41, Springer-Verlag Italia 2014
137
138 P. D’Aprile and A. Tarantino
Postoperative Follow-Up
Fig. 2 a–b.SET1(a) FSE fat sat T2 (b). No imaging and clinical improvement