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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_6040_Библиотеки_им_академика_М_И_Перельмана.pdf
Degenerative Lumbar Instability Interspinous Device Positioning
Fibrous Scar and Infection
Paola D’Aprile and Alfredo Tarantino
• Patient with persisting and increasing degenerative low back pain
treated by L4–L5 interspinous device positioning
• MR late postoperative follow-up
Late Postoperative Follow-Up
Fig. 1 a–f. CE fat sat SE
T1 sagittal (a–b), coronal
(c), and axial (d–f). CE of
soft tissue surrounding
device at L4–L5 due to
scar and infection (cause of
pain)
Case
42
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_47, Springer-Verlag Italia 2014
149
150 P. D’Aprile and A. Tarantino
Fig. 1 (continued)
Degenerative Lumbar Instability Interspinous Device Positioning
Fibrous Stenosis
Ferdinando Caranci, Domenico Cicala, Vincenzo Giugliano,
Francesco Briganti and Luca Brunese
Preoperative Imaging
Fig. 1 a–j. SE T1 sagittal
(a–c), FSE T2 sagittal (d–
f), and SE T1 axial sections
(g–j). L4–L5 disk
protrusion occupying both
inferior foraminal recesses;
narrowing of canal (a–f).
Left lamino-flavectomy
(arrow) with fibrous scar in
left epidural space (g–j,
arrowhead)
Case
43
• Patient treated by removal of L4–L5 herniated disk with previous left
lamino-flavectomy. Persisting left low back pain and claudication
requires interspinous device positioning with subsequent worsening
of clinical conditions and imaging
• MR preoperative imaging and late postoperative follow-up (3 months)
F. Caranci (&) F. Briganti
Advanced Biomedical Sciences Department, Unit of Neuroradiology, ‘‘Federico II’’ University, Naples, Italy
e-mail: ferdinandocaranci@libero.it
D. Cicala
Unit of Diagnostic Imaging, Villa Fiorita Clinic, Capua, CE, Italy
V. Giugliano
Unit of Diagnostic Imaging, GE.P.O.S. Clinic, Telese Terme, BN, Italy
L. Brunese
Department of Health Science, Chair of Radiology, University of Molise, Campobasso, Italy
T. Scarabino and S. Pollice (eds.), Imaging Spine After Treatment,
DOI: 10.1007/978-88-470-5391-5_48, Springer-Verlag Italia 2014
151
152 F. Caranci et al.
Fig. 1 (continued)
Case 43 - Degenerative Lumbar Instability 153
Postoperative Follow-Up After 3 Months
Fig. 2 a–j. SE T1 sagittal (a–c), FSE T2 sagittal (d–f), and SE T1 axial sections (g–j). L4–L5 DIAM. Interspinous
diastase and fibrous scar cause a reduction of sagittal diameter of the vertebral canal with compression of posterior
profile of the dural sac (e, arrow). Clinical worsening of radicular pain. Hypertrophy of epidural fatty tissue
(g, arrowhead) contributes to stenosis
154 F. Caranci et al.
Fig. 2 (continued)
Degenerative Lumbar Instability Interspinous Device Positioning
Septic Spondylodiscitis
Paola D’Aprile and Alfredo Tarantino
• Patient with persisting low back pain and high level flogosis
markers after interspinous device positioning
• Late MR postoperative follow-up (2 months)
Postoperative Follow-Up After 2 Months
Fig. 1 a–h.SET1(a–b),
FSE fat sat T2 (c–
d) sagittal, CE fat sat SE
T1sagittal (e–f) and axial
(g–h). Severe
spondylodiscitis (T1
hypointensity a–b,T2
hyperintensity c–d)CEof
disk, spongiosa,
paravertebral soft tissue
and right psoas muscle
(e–h). Intracanal expansion
and soft tissue microabscesses along surgical
breach
Case
44
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_49, Springer-Verlag Italia 2014
155
156 P. D’Aprile and A. Tarantino
Fig. 1 (continued)
Degenerative Lumbar Instability Stabilization and Interspinous Device Positioning
Regular Findings
Tommaso Scarabino, Angela Lorusso, Pietro Maggi,
Carmen Bruno and Michele Santoro
• Patient with low back pain in vertebral instability treated by
stabilization through L4-L5 screws, bars and previously
by interspinous device (X-Stop)
• Early XR/MR postoperative follow-up
Postoperative Follow-Up
Fig. 1 a–b. XR lateral
(a) and anteroposterior (b)
Case
45
T. Scarabino (&) A. Lorusso P. Maggi
Department of Radiology—Neuroradiology, ‘‘Lorenzo Bonomo’’ Hospital, Andria, Italy
e-mail: tscarabino@hotmail.com
C. Bruno 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_50, Springer-Verlag Italia 2014
157
Degenerative Lumbar Instability Rigid Posterior Stabilization
Regular Findings
Teresa Popolizio, Francesco Gorgoglione
and Giuseppe Guglielmi
Preoperative Imaging
Fig. 1 XR lateral. L5-S1
anterolisthesis
Case
46
• Patient with low back pain which extends to arms in L5-S1 degener-
ative listhesis treated by posterior rigid stabilization and transpeduncular screws positioning
• XR preoperative imaging and postoperative follow-up
T. Popolizio (&)
Department of Neuroradiology, Scientific Institute Hospital ‘‘Casa Sollievo della Sofferenza’’,
San Giovanni Rotondo (Fg), Italy
e-mail: t.popolizio@libero.it
F. Gorgoglione
Department of Orthopedics, Scientific Institute Hospital ‘‘Casa Sollievo della Sofferenza’’,
San Giovanni Rotondo (Fg), Italy
G. Guglielmi
Department of Radiology, Scientific Institute Hospital ‘‘Casa Sollievo della Sofferenza’’,
San Giovanni Rotondo, FG, Italy
G. Guglielmi
Department of Radiology, University of Foggia, Foggia, Italy
T. Scarabino and S. Pollice (eds.), Imaging Spine After Treatment,
DOI: 10.1007/978-88-470-5391-5_51, Springer-Verlag Italia 2014
159