CME 13 Session - EANM'16

Bone & Joint & ESSR (Interactive): The Post-Operative Spine

Educational objectives:
  1. Understand the rationale and principles of spinal surgery techniques
  2. Integrate changes in biomechanics after surgery with possible causes of recurrent symptoms
  3. Know the strengths and limitations of anatomical imaging techniques in the post-operative spine
  4. Apply appropriateness criteria for nuclear medicine imaging after spine surgery
  5. Select the optimal nuclear medicine imaging technique for an individual patient
  6. Interpret scintigraphic patterns of common causes of long-term symptoms after spine surgery
  7. Recognise relevant anatomic changes on correlative CT images as part of hybrid studies
  8. Integrate functional and anatomical findings of hybrid studies in post-operative spine

Worldwide the number of spine surgeries has increased significantly over the past decade. Even though the indications for lumbar spine surgery have not been rigorously defined, procedures performed for debilitating pain from degenerative spinal disease account for an increasing share of the total number of interventions performed. With an ageing population this trend is likely to continue for some time. Unfortunately, late onset (1-3 year  post-operative) recurrent pain after surgery is frequent and occurs in 10-40% of patients. Main causative conditions are pseudarthrosis, instrumentation-related complications, adjacent-segment disease, spinal and sacral fractures, and infection.

In this interactive state-of-the-art CME session the rationale and principles of spinal surgery will be illustrated. Next, the strengths and limitations of radiological imaging techniques (X-ray, CT, MRI, EOS) will be explained. Increasing evidence is emerging that hybrid nuclear medicine imaging techniques (SPECT/CT, PET/CT) can provide useful clues to identify clinically relevant sources of late onset recurrent pain in these patients. The complementary value of these techniques will be reviewed with focus on the changes in biomechanics occurring after surgery as possible causes for recurrent symptoms. Both scintigraphic patterns and findings on correlative CT studies will be highlighted. Key concepts will be illustrated using patient material and audience participation maximized through electronic voting.

Key Words:

Spine, post-operative, radiology, hybrid imaging, SPECT/CT, PET/CT

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