SPINAL INSTABILITY- MISSED ON CT AND MRI IMAGING

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SPINAL INSTABILITY- MISSED ON CT AND MRI IMAGING

• Manoj Krishna , Mch Orth,FRCS,Spinal Surgeon
• Shailesh Hadgaonkar,MS Orth, D.Orth, FCPS
  Orth,Spinal Fellow

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History-

• Present complains-
• 38 yr/ man,ref .to us from south of England
• C/o-Persistant back pain, right leg pain right
  leg started giving way.
• Unable to walk 100 yards.

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Past History

• Year 1991- Laminectomy in USA
• Next dayRevision Surgery L5-s1 Postero lateral
  fusion ,did well for many years,again started
  complaining of back pain.
• L4-5 posterior lumbar interbody fusion in Uk,last
  year.
• He was ok for few weeks, again stated
  complaining of back,leg Pain, walking difficulty

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MRI scan

• T2 SAG.

• ARTEFACT WITH INTERBODY DEVICE _at_ l4-5

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\

• T1 SAG

• AXIAl

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CT scan study

• SAG

• Interbody device _at_ L4-5

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• Coronal- Non union _at_ L4-5

• Cages-Axial

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Dynamic X rays

• AP view

• Standing Lateral

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Instability L34 Angulation, Translation,
Deformity

• Flexion

• Extension

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Learning Points

• Spinal Instability is not shown on CT and MRI
  scans or ordinary x-rays.
• Dynamic Flexion-Extension X-rays are needed to
  demonstrate this.
• Stand alone interbody fusion cages rarely work in
  my experience and this patient needs revision
  surgery