Lumbosacral fusion with LBP 14 months post op MRI Help Please

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55F 14 mos post L5-S1 anterior interbody fusion with LBP.
I consulted with my neuro colleague who disregards the bright STIR signal
at the inferior endplate of L5 as metal artifact and favors the BME-like
signal on STIR to be residual Modic change.
The reason I don’t believe the metal artifact is because it looks like we
see the metal bone interface so clearly on PD and there seems to be a
gap…does this suggest that the device is not incorporated into the
inferior endplate of L5?
Should I recommend CT? or do you agree with my neuro colleague and I
should read this as normal?

[image: Consult L sp fusion 14mos 55F LBP.jpg]
[image: Consult L sp fusion 14mos 55F LBP (1).jpg]
[image: Consult L sp fusion 14mos 55F LBP (2).jpg]
[image: Consult L sp fusion 14mos 55F LBP (3).jpg]

pdf icon Consult-L-sp-fusion-14mos-55F-LBP.pdf

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1 thought on “Lumbosacral fusion with LBP 14 months post op MRI Help Please”

  1. hilary.umans
    hilary.umans

    Thanks to the many OCADers who have indicated that the finding is real and
    suggests lack of incorporation of the fusion device.
    There is subtle lucency around the flanges on XR—-but I didn’t know if that
    was abnormal 3-4 months post – op.
    The MRI was 11 months after XR.

    I have recommended CT and XR with flexion and extension. We shall see.

    Hilary

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