Spine imaging after lumbar disc replacement: pitfalls and current recommendations.

Area of Science:

• Spinal surgery
• Biomaterials
• Diagnostic imaging

Background:

• Most lumbar artificial discs utilize stainless steel alloys, posing challenges for postoperative magnetic resonance imaging (MRI).
• Patients with stainless steel implants experiencing radicular symptoms or claudication often need alternative diagnostic methods.

Purpose of the Study:

• To review potential complications following lumbar total disc replacement (TDR).
• To provide imaging recommendations based on implant type.
• To illustrate findings with clinical cases.

Main Methods:

• Literature review of lumbar total disc replacement (TDR) complications.
• Analysis of imaging modalities for different implant materials.
• Presentation of two illustrative patient cases.

Main Results:

• Complications like infections, implant wear, loosening, fracture, and stenosis are visible with both titanium and stainless steel implants.
• Magnetic artifacts from stainless steel implants necessitate different imaging techniques compared to titanium.
• Various complications including facet joint hypertrophy and ankylosis can be visualized.

Conclusions:

• Alternative radiographic procedures are crucial for evaluating patients post-lumbar TDR.
• Myelography and radionuclide techniques can visualize complications like spinal stenosis and implant loosening, even with stainless steel implants.
• These methods serve as valuable adjuncts to plain film radiographs for comprehensive diagnosis.