Neurology and Neurosurgery

Biography

Biography: Roberto Cartolari

Abstract

The so-called failed back surgery syndrome (FBSS) is a common problem that often remains without a clear diagnosis. The diagnostic workout is complex and usually based on conventional X-ray films, MRI, CT and sometimes myelography and myelo-CT, especially if some mechanical device has been implanted. In the most part of the cases, an exact cause for low back pain and/or sciatic pain is hard to define and this can influence a correct therapy. The most important consideration is the difficulty to have a functional approach to the operated spine since the most part of the diagnostic procedures are made with the patient in rest position (supine). On the other hand metallic implants can interfere with MR and CT acquisitions. The only dynamic diagnostic procedure (orthostatic functional X-ray plain film) has known lack of precision. In last years, the possibility of functional studies in real or simulated orthostatism (orthostatic MR and axial loaded CT and MR) has led to a deeper comprehension of the mechanics of the operated spine, especially of the instrumented spine. In this lecture, the results of more than 20 years of experience with axial loaded CT and MRI will be presented. The axial loaded CT imaging could be the gold standard in the evaluation of the post-op lumbar spine, in particular when a mechanical device has been implanted.