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  1. SPINAL INSTABILITY- MISSED ON CT AND MRI IMAGING Manoj Krishna , Mch Orth,FRCS,Spinal Surgeon Shailesh Hadgaonkar,MS Orth, D.Orth, FCPS Orth,Spinal Fellow

  2. History- • Present complains- • 38 yr/ man,ref .to us from south of England • C/o-Persistant back pain, right leg pain &right leg started giving way. • Unable to walk 100 yards.

  3. Past History • Year 1991- Laminectomy in USA • Next day=Revision Surgery & L5-s1 Postero lateral fusion ,did well for many years,again started complaining of back pain. • L4-5 posterior lumbar interbody fusion in Uk,last year. • He was ok for few weeks, & again stated complaining of back,leg Pain, walking difficulty

  4. MRI scan T2 SAG. ARTEFACT WITH INTERBODY DEVICE @ l4-5

  5. \ T1 SAG AXIAl

  6. CT scan study SAG Interbody device @ L4-5

  7. Coronal- Non union @ L4-5 Cages-Axial

  8. Dynamic X rays AP view Standing Lateral

  9. Instability –L34 Angulation, Translation, Deformity Flexion Extension

  10. Learning Points • Spinal Instability is not shown on CT and MRI scans or ordinary x-rays. • Dynamic Flexion-Extension X-rays are needed to demonstrate this. • Stand alone interbody fusion cages rarely work in my experience and this patient needs revision surgery