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Imaging pitfalls of interbody spinal implants.

G R Cizek1, L M Boyd

  • 1Department of Radiology; St. Anthony's Medical Center, St. Louis, Missouri 63128, USA. gcizek@pol.net

Spine
|October 18, 2000
PubMed
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Computed tomography (CT) offers superior imaging of interbody implants compared to plain radiography, accurately detecting intraimplant bone and improving lucency visualization. Metallic implants cause artifacts, complicating interpretation, while nonmetallic implants show lucencies more clearly on CT.

Area of Science:

  • Spinal imaging techniques
  • Orthopedic implant assessment
  • Radiographic interpretation

Background:

  • Postoperative lucencies around bone dowel implants can resolve.
  • Diagnosing fusion with metallic implants is challenging due to false positives/negatives.
  • Limited literature exists on imaging interbody implants.

Purpose of the Study:

  • Investigate sources of interpretation error in computed tomography (CT) and plain radiography of interbody implants.
  • Evaluate the basic imaging characteristics of various interbody implants.
  • Compare the efficacy of CT and plain radiography in assessing spinal fusion and implant-related findings.

Main Methods:

  • Imaged diverse interbody implants in cadaveric spines using CT and plain radiography.

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  • Placed four interbody constructs under varied conditions for imaging.
  • Evaluated implant imaging characteristics and potential interpretation errors.

    • Main Results:

    • CT accurately predicted intraimplant bone, unlike plain radiographs.
    • Metallic implants produced 1-3 mm CT artifacts, hindering peri-implant assessment.
    • Lucencies were more visible on CT than plain radiographs; nonmetallic implants showed 4:1 greater lucency visibility on CT.

    Conclusions:

    • Identified interpretation errors in assessing bridging bone, lucency, and peri-implant detail obscured by metallic artifact.
    • Nonmetallic implants revealed lucencies more clearly than metallic constructs.
    • Plain radiography underestimated lucencies for metallic implants but overestimated them for nonmetallic implants.