Post ACDF Imaging

[NJPAIN]

This one is particularly for the radiologists among us.

Outside of the immediate postoperative period and/or where there are concerns of infection and tumor, is there any value to the administration of contrast to a patient post ACDF who is a few years post surgery? I can find some clear guidance regarding posterior lumbar surgery within 7-10 years but nothing regarding anterior cervical surgery.

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[lobelsteve]

Don't see benefit in either. Scar vs disc in L-spine, but history usually gives that away.
No changes in C-spine to see with contrast unless tumor, infection. Don't think scar vs disc is seen there.

 

[lonelobo]

Agree with Lobel and that is what our Radiologists say

 

[NOSfan]

NJP,

I have found the following articles useful.

Cheers

 

[metadr]

Discussing the same question with my local radiologist, the answer is no. May be worth it if there was fusion from posterior approach.

 

[willabeast]

had discussion with recently trained neuroradiologist 2 weeks ago.
unless concerned about infection or cancer, no need for Gadolinium contrast if spine operation was one year or older. less than one year since operation would consider using Gad.

 

[NJPAIN]

Thanks for the thoughtful responses. You confirmed what i believed was true. I just see so many spine surgeons ordering contrast enhanced studies on ALL patients who had prior surgery that I was questioning my reasoning.

 

[bedrock]

Thanks for the thoughtful responses. You confirmed what i believed was true. I just see so many spine surgeons ordering contrast enhanced studies on ALL patients who had prior surgery that I was questioning my reasoning.

Unfortunately surgeons of all types are often unconcerned re medical issues.

More and more studies coming out on potential side effects of IV Gad. I don't order contrast unless it's truly necessary.

 

[drpainfree]

"Don't see benefit in either. Scar vs disc in L-spine, but history usually gives that away."

allow me to quote you here, steve. can you share how you can differentiate si/sx of post-lami pain syndrome? I always had the question and thought MRI with and w/o contrast is necessary to tell the difference.

 

[Ducttape]

"Don't see benefit in either. Scar vs disc in L-spine, but history usually gives that away."

allow me to quote you here, steve. can you share how you can differentiate si/sx of post-lami pain syndrome? I always had the question and thought MRI with and w/o contrast is necessary to tell the difference.

Remember the First Dictum of Chronic Pain...


When chuck Norris wants to know something about the pathophysiology of pain... He calls lobelsteve.

 

[lobelsteve]

"Don't see benefit in either. Scar vs disc in L-spine, but history usually gives that away."

allow me to quote you here, steve. can you share how you can differentiate si/sx of post-lami pain syndrome? I always had the question and thought MRI with and w/o contrast is necessary to tell the difference.

The answer in scar vs disc is time course and history. New trauma, sudden onset, reliable aggravating and relieving factors = disc. Insidious onset worse over time and not better by change in position or activity = scar.

 

[drpainfree]

thanks for the input, steve.

 

[lobelsteve]

Remember the First Dictum of Chronic Pain...


When chuck Norris wants to know something about the pathophysiology of pain... He calls lobelsteve.

 

[freddydpt]

Just saw this thread... agree... no benefit of contrast I can think of... if worried about hardware loosening then plain film and noncontrast MRI can show it.