Leon Trevor, Kwok Witty, Lindsay Justin, Costa Marcelo, Staarmann Brittany
Wright State University Boonshoft School of Medicine, Fairborn, Ohio.
Department of Neurosurgery, Premier Health Miami Valley Hospital, Dayton, Ohio.
J Neurosurg Case Lessons. 2025 Sep 15;10(11). doi: 10.3171/CASE25358.
Metallic implants can cause imaging artifacts on CT and MRI. Although metal artifact reduction (MAR) techniques have enhanced imaging clarity, they can also lead to distortions that may resemble complications such as hardware fractures. The false appearance of fractured hardware, or "pseudofractures," can distort imaging interpretation and result in unnecessary revision surgery.
A 65-year-old male sustained a T12-L1 fracture extending through the disc space with ligamentous interruption after a bicycle accident. The patient underwent T11-L2 posterior fusion with pedicle screws and was discharged in a thoracolumbar sacral orthosis brace after an uncomplicated postoperative course. Concerns about brace compliance prompted imaging, which demonstrated screw fractures and led to discussion of revision procedure. Repeat imaging revealed that these were artifacts, not hardware failure. No revision was needed and the patient continued to recover.
This case emphasizes the importance of understanding imaging techniques that may impact interpretation and implications for surgical decision-making. Imaging artifacts should be considered when hardware fractures exist at multiple levels without suggestive history of new symptoms. Obtaining plain radiographs or images without MAR may assist in diagnostic uncertainty. Discussing MAR use with the radiology department at imaging acquisition may improve both imaging interpretations and resource utilization. https://thejns.org/doi/10.3171/CASE25358.
金属植入物可在CT和MRI上产生成像伪影。尽管金属伪影减少（MAR）技术提高了成像清晰度，但它们也可能导致变形，这种变形可能类似于硬件骨折等并发症。硬件骨折的假象，即“假性骨折”，会扭曲成像解读并导致不必要的翻修手术。
一名65岁男性在自行车事故后发生T12-L1骨折，骨折延伸至椎间盘间隙并伴有韧带中断。患者接受了T11-L2后路融合术并使用椎弓根螺钉固定，术后过程顺利，出院时佩戴胸腰骶矫形支具。对支具依从性的担忧促使进行影像学检查，结果显示螺钉骨折，进而引发了关于翻修手术的讨论。重复成像显示这些是伪影，而非硬件故障。无需进行翻修，患者继续康复。
本病例强调了理解可能影响解读及手术决策的成像技术的重要性。当多个层面存在硬件骨折且无新症状提示病史时，应考虑成像伪影。获取无MAR的平片或图像可能有助于解决诊断不确定性。在进行成像检查时与放射科讨论MAR的使用，可能会改善成像解读并提高资源利用效率。https://thejns.org/doi/10.3171/CASE25358
