Introduction

Interpretation of a lumbar spine MRI in the immediate postoperative period is challenging, as postoperative tissue enhancement and fluid collections may be mistaken for infection. Radiology reports may use ambiguous language, creating a clinical problem for a surgeon in determining whether a patient needs treatment with antibiotics or revision surgery. Moreover, retrospective criticism of management in instances of a true infection may lead to medicolegal ramifications.

Methods

A retrospective review of patients undergoing posterior-approach lumbar decompressive surgery with or without fusion over a 30-month period identified those undergoing postoperative MRI within 10 weeks of surgery. Patients initially operated upon for infection were excluded. The MRI reports were analyzed for language describing findings suspicious for infection and those of these with true infections were identified.

Results

Of 487 patients undergoing posterior lumbar spine decompression surgery, 68 (14%) had postoperative MRI within 10 weeks. Of these, the radiology reports raised suspicion for infection in 20 (29%), of which 2 (10%) patients had a true infection. Two patients underwent reoperation for new motor deficit from seroma/hematoma. Of 63 patients who had MRI to evaluate complaints of back and/or leg pain without new motor deficits, the MRI significantly altered management in 3 patients (4.8%).

Conclusion

Radiology reports of postoperative lumbar spine MRIs frequently use language that raises suspicion for infection; but it is uncommon, however, that these patients harbor true infections. A radiology report describing possible infectious findings may not be considered significant without corroboration with other laboratory and clinical data.

中文翻译：

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术后腰椎 MRI：怀疑感染的放射学报告与真正的临床感染的相关性如何？

介绍

术后即刻对腰椎 MRI 的解释具有挑战性，因为术后组织增强和积液可能被误认为是感染。放射学报告可能使用模棱两可的语言，这给外科医生在确定患者是否需要抗生素治疗或翻修手术时造成临床问题。此外，在真正感染的情况下对管理的回顾性批评可能会导致法医学后果。

方法

一项对 30 个月内接受后路入路腰椎减压手术融合或不融合的患者的回顾性研究确定了那些在手术后 10 周内接受术后 MRI 的患者。最初因感染而接受手术的患者被排除在外。分析了 MRI 报告中描述可疑感染的发现的语言，并确定了那些真正感染的发现。

结果

在 487 名接受后路腰椎减压手术的患者中，68 名（14%）在 10 周内进行了术后 MRI。其中，放射学报告怀疑有 20 名 (29%) 感染，其中 2 名 (10%) 患者有真实感染。两名患者因血清肿/血肿引起的新的运动障碍接受了再次手术。在 63 名接受 MRI 评估背部和/或腿部疼痛主诉但没有新的运动缺陷的患者中，MRI 显着改变了 3 名患者 (4.8%) 的管理。

结论

术后腰椎 MRI 的放射学报告经常使用引起怀疑感染的语言；但是，这些患者真正感染的情况并不常见。如果没有其他实验室和临床数据的证实，描述可能的感染性发现的放射学报告可能不会被认为是重要的。