11.5.16  Gossypiboma

11.5.16.1\ Discussion

Retained surgical sponges can form gossypibomas, which are masses of cotton surrounded by foreign-body reaction. These are uncommon

a

c

after spine surgery. Most gossypibomas reside in the paraspinal soft tissues in the vicinity of the surgical site (Fig. 11.115). These usually range in size from 3.5 to 5.0 cm. Patients often present with nonspecific back pain. On MRI, gossypibomas characteristically display hyperintense

b

d

Fig. 11.115  Gossypiboma. The patient has a history of spine surgery for lumbar stenosis many years prior in an underdeveloped country. Axial CT (a) shows well-defined right paravertebral mass (arrow). No radiopaque marker

was found. Sagittal T2-weighted (b), T1-weighted (c), and post-contrast T1-weighted (d) MR images demonstrate a mass in the right paraspinal muscles with peripheral enhancement and a hyperintense core on T2 (arrows)

centers surrounded by low signal intensity on T2-weighted images and peripheral enhancement on post-contrast T1-weighted sequences. Most sponges contain radiopaque markers that can be recognized on CT and radiographs. However, some institutions may use sponges without radiopaque markers. On CT, gas bubbles or calcifications may be apparent, depending on the age of the gossypiboma.

11.5.17  Adjacent Segment

Degenerative Disease

11.5.17.1\ Discussion

Adjacent segment disease is a process related to spinal fusion in which degenerative change may develop at an accelerated pace at the mobile level next to fused level. This can lead to symptoms that can require additional surgical intervention. Radiographic signs of degenerative change adjacent to a fuse level are not uncommon. Potential findings include facet hypertrophy, disc herniation, loss of disc space height, and endplate changes (Fig. 11.116). The incidence of symptomatic adjacent degenerative disease is higher with pedicle instrumented fusion than other types of instrumented fusion.

Fig. 11.116  Development of adjacent level degenerative disease. The patient underwent transforaminal lumbar interbody fusion at L3–L4 and L4–L5 and posterior lumbar arthrodesis L2–L5. Two years later, the patient began to experience symptoms consistent with cauda equina and conus medullaris compression. Preoperative sagittal CT

image (a) shows no significant degenerative disease at L1–L2. Postoperative sagittal CT image (b) obtained 2 years later shows new facet hypertrophy (arrow), disc space narrowing, and endplate sclerosis at L1–L2. Spinal fusion hardware is partially visible