Plates and Screws

KEY FACTS

Terminology

• Instrumentation in fusion surgery designed to stabilize, not replace, spinal bony elements

Imaging

• Postoperative imaging: Assess progress of osseous fusion, confirm correct positioning & integrity of instrumentation, detect suspected complications (e.g., infection or hematoma), & detect new disease or disease progression

• Radiographs

  • Noninvasive, most common for assessment of fusion

  • Instrumentation break or periimplant lucency

• CT

  • Modality of choice for imaging bony detail to enable accurate assessment of degree of osseous fusion

• MR

  • Useful for detecting and monitoring infection or postoperative collections

Clinical Issues

• Complications

  • Pseudoarthrosis, instrumentation fractures

  • Surgical approach risks: Nerve or vascular injury, dural tear

  • Infection

  • Instrumentation malposition

Diagnostic Checklist

• Compare current radiographs with multiple previous studies

  • Identify subtle progressive changes in spinal alignment & in position of instrumentation devices that may signify imminent failure of device or other complications

TERMINOLOGY