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Postoperative Wirbelsäule

Postoperative spinal column

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Zusammenfassung

Standardverfahren

In der Regel erfolgt bei spinalen Eingriffen eine postoperative Bildgebung, um die exakte Lage des Implantatmaterials zu dokumentieren.

Informationen

Unbedingt notwendig ist die Bildgebung, wenn postoperativ neue klinische Symptome aufgetreten sind. Hier müssen eine Nachblutung bzw. inkorrekte, eine Wurzel oder das Myelon tangierende Implantatlage nachgewiesen werden. Neben diesen direkt postoperativ auftretenden klinischen Symptomen gibt es eine Reihe von Komplikationen, die erst nach mehreren Tagen, Wochen oder sogar nach Monaten auftreten können. Hierzu zählen das Failed-back-surgery-Syndrom, die Implantatlockerung oder -bruch, aber auch ein Rezidivvorfall und die Spondylodiszitis.

Bewertung

Neben der Kenntnis der ursprünglichen Symptome ist es auch wichtig, die Operationsdetails zu kennen, wie z. B. Zugangswege und verwendetes Material.

Empfehlung

In fast allen postoperativen Fällen ist eine Bildgebung mit Kontrastmittel(KM)-Gabe und entsprechender Korrektur der Artefakte durch das Implantatmaterial wie Dual-energy-Technik, Korrekturalgorithmen bzw die Verwendung besonderer MR-Sequenzen notwendig.

Empfehlung

Um die portoperative Bildgebung korrekt beurteilen zu können, sind neben besonderen CT-Techniken bzw. MR-Sequenzen Kenntnisse des Operationsverfahrens und der vorangehenden klinischen Symptome notwendig.

Abstract

Standard procedure

As a rule, postoperative imaging is carried out after spinal interventions to document the exact position of the implant material.

Information

Imaging is absolutely necessary when new clinical symptoms occur postoperatively. In this case a rebleeding or an incorrect implant position abutting a root or the spinal cord must be proven. In addition to these immediately occurring postoperative clinical symptoms, there are a number of complications that can occur several days, weeks or even months later. These include the failed back surgery syndrome, implant loosening or breakage of the material and relapse of a disc herniation and spondylodiscitis.

Review

In addition to knowledge of the original clinical symptoms, it is also important to know the operation details, such as the access route and the material used.

Recommendation

In almost all postoperative cases, imaging with contrast medium administration and corresponding correction of artefacts by the implant material, such as the dual energy technique, correction algorithms and the use of special magnetic resonance (MR) sequences are necessary.

Recommendation

In order to correctly assess the postoperative imaging, knowledge of the surgical procedure and the previous clinical symptoms are mandatory besides special computed tomography (CT) techniques and MR sequences.

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Authors and Affiliations

  1. Abteilung für Wirbelsäulenchirurgie, Westpfalzklinikum GmbH, Standort II, Kusel, Deutschland

    W. Käfer

  2. Institut für Radiologie II, Westpfalzklinikum GmbH, Standort II, Kusel, Deutschland

    I. Heumüller

  3. Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, 66424, Homburg/Saar, Deutschland

    N. Harsch, C. Kraus &  W. Reith

Authors
  1. W. Käfer
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  2. I. Heumüller
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  3. N. Harsch
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  4. C. Kraus
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  5. W. Reith
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Corresponding author

Correspondence to W. Reith.

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Interessenkonflikt

W. Käfer, I. Heumüller, N. Harsch, C. Kraus und W. Reith geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Käfer, W., Heumüller, I., Harsch, N. et al. Postoperative Wirbelsäule. Radiologe 56, 698–707 (2016). https://doi.org/10.1007/s00117-016-0130-x

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  • DOI: https://doi.org/10.1007/s00117-016-0130-x

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