Seroma and Epidural Scar
Epidural Hematoma - CT
Epidural Hematoma - MRI
Displaced Strut Graft
Screw in Spinal Canal
Screw in Disc space
Screw Loosening & Hematoma
Screw Backing Out
Screw Loosening and Hematoma
73 y.o male, s/p C5-6 corpectomy and anterior fusion of C4-6 with anterior
plating for gradual bilateral upper extremity weakness and eventually bowel dysfunction. 5
days after the surgery, while in the hospital, the patient was struck by a food
services cart. Noting after that incident, more pain and a new 'click' sound in
the neck, further imaging was obtained.
|Immediate post-op radiograph demonstrate good position of
the graft and fixation plate.
| This is lateral radiograph taken several hours AFTER the incident
with the food truck. Note the distal end of the fixation plate has loosened and
is nearly completely out. The distal screws have minimal purchase in the C7 vertebral
| Sagittal T2 FSE (A), sagittal T1 pre (B) and post contrast
administration (C) show the graft with blooming artifact where the
plate exists anteriorly as well as the screw (lower portion of the image). The
susceptibility artifact of the screw shows its ventral positioning essentially
outside of the C7 vertebral body. Also, there is T2 hyperintense fluid
surrounding the surgical site with the graft material is now surrounded by
nonenhancing mixed signal intensity material, predominately hypointense on T1
and hyperintense on T2, possibly suggesting some blood products. There is
enhancement in both the anterior and posterior epidural spaces. The distal end
of the fixation plate with the screw in the C6 vertebral body appears now
displaced anteriorly and there is significant prevertebral soft tissue swelling.
Also, this fluid- like material surrounding the bone graft appears to cause some
narrowing of the spinal canal, with some mild spinal canal stenosis.
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