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Medical Devices of the Head, Neck, and Spine¹

¹ From the Departments of Radiology (T.B.H., W.G.B.) and Orthopaedic Surgery (R.B.D.), University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067; Arizona State Radiology, Tucson, Ariz (M.T.Y.); and Rick Light, DDS, Tucson, Ariz (R.A.L.). Received August 22, 2003; revision requested September 2 and received October 13; accepted October 13. Address correspondence to T.B.H. (e-mail: tbh@3towers.com).

View larger version (134K): [in a new window]   Figure 1.  Standard CSF shunt. Lateral radiograph of the skull (see also Fig 11) shows a typical CSF shunt (arrows). There are also four aneurysm clips (black arrowheads) near the circle of Willis, scalp (skin) staples (white arrowheads), craniotomy fixation plugs (*), and dental fillings.

View larger version (127K): [in a new window]   Figure 2a.  Programmable shunt. (a) Lateral radiograph of the skull shows a Codman-Hakim programmable shunt (arrows). (b) Close-up view of the shunt shows its programmable valve (arrow).

View larger version (161K): [in a new window]   Figure 2b.  Programmable shunt. (a) Lateral radiograph of the skull shows a Codman-Hakim programmable shunt (arrows). (b) Close-up view of the shunt shows its programmable valve (arrow).

View larger version (137K): [in a new window]   Figure 3.  Cross-table postoperative lateral radiograph of the skull shows recording electrodes (arrows) that lie on the brain surface bilaterally. Scalp (skin) staples and postoperative air can also be seen anteriorly under the frontal bone.

View larger version (166K): [in a new window]   Figure 4a.  Scout CT view of the skull (a) and CT image of the cranium (b) show a right intracranial pressure monitor in a patient with recent intracranial brain shear injuries.

View larger version (106K): [in a new window]   Figure 4b.  Scout CT view of the skull (a) and CT image of the cranium (b) show a right intracranial pressure monitor in a patient with recent intracranial brain shear injuries.

View larger version (124K): [in a new window]   Figure 5.  Close-up radiograph of the skull shows recently placed subdural recording electrodes.

View larger version (147K): [in a new window]   Figure 6a.  (a) Lateral radiograph of the skull shows bilateral deep brain stimulators implanted to treat Parkinson disease. (b, c) CT (b) and MR (c) images of the same patient show the stimulators in the thalamus on each side.

View larger version (142K): [in a new window]   Figure 6b.  (a) Lateral radiograph of the skull shows bilateral deep brain stimulators implanted to treat Parkinson disease. (b, c) CT (b) and MR (c) images of the same patient show the stimulators in the thalamus on each side.

View larger version (177K): [in a new window]   Figure 6c.  (a) Lateral radiograph of the skull shows bilateral deep brain stimulators implanted to treat Parkinson disease. (b, c) CT (b) and MR (c) images of the same patient show the stimulators in the thalamus on each side.

View larger version (176K): [in a new window]   Figure 7.  Lateral scout radiograph of the skull shows cerebellar stimulators (arrow).

View larger version (140K): [in a new window]   Figure 8.  Cranial plate in a 77-year-old man who suffered extensive head wounds from a mortar in the Philippines in 1944. Scout CT image of the cranium shows a metallic cranial plate that was placed emergently at a battlefield hospital. It has given the patient no trouble since the Second World War.

View larger version (129K): [in a new window]   Figure 9.  Young child with recent cranial surgery for coronal suture craniosynostosis. Lateral radiograph shows a cranial plate (arrow) under the surgically created coronal suture.

View larger version (127K): [in a new window]   Figure 10a.  Intracranial embolic materials. (a) Frontal radiograph of the skull shows a platinum coil (arrow) in a small, distal middle cerebral artery branch. It does not look circular, because it has conformed to the shape of the artery. (b) Massive hemorrhage not controlled by surgery in a 61-year-old man who had undergone radiation therapy for unresectable squamous cancer of the neck. Frontal view from angiography shows that the right external carotid artery has been occluded by multiple platinum coils. (c) Lateral view from angiography shows cyanoacrylate glue (arrow) that occludes an arterial venous malformation. (Courtesy of Gary Duckwiler, Los Angeles, Calif.) (d) On a CT scan, polyvinyl alcohol is difficult to see. If the patient undergoes imaging immediately after embolization, as in this case, the clot produced by polyvinyl alcohol may be seen as a linear area of increased attenuation (arrow).

View larger version (130K): [in a new window]   Figure 10b.  Intracranial embolic materials. (a) Frontal radiograph of the skull shows a platinum coil (arrow) in a small, distal middle cerebral artery branch. It does not look circular, because it has conformed to the shape of the artery. (b) Massive hemorrhage not controlled by surgery in a 61-year-old man who had undergone radiation therapy for unresectable squamous cancer of the neck. Frontal view from angiography shows that the right external carotid artery has been occluded by multiple platinum coils. (c) Lateral view from angiography shows cyanoacrylate glue (arrow) that occludes an arterial venous malformation. (Courtesy of Gary Duckwiler, Los Angeles, Calif.) (d) On a CT scan, polyvinyl alcohol is difficult to see. If the patient undergoes imaging immediately after embolization, as in this case, the clot produced by polyvinyl alcohol may be seen as a linear area of increased attenuation (arrow).

View larger version (122K): [in a new window]   Figure 10c.  Intracranial embolic materials. (a) Frontal radiograph of the skull shows a platinum coil (arrow) in a small, distal middle cerebral artery branch. It does not look circular, because it has conformed to the shape of the artery. (b) Massive hemorrhage not controlled by surgery in a 61-year-old man who had undergone radiation therapy for unresectable squamous cancer of the neck. Frontal view from angiography shows that the right external carotid artery has been occluded by multiple platinum coils. (c) Lateral view from angiography shows cyanoacrylate glue (arrow) that occludes an arterial venous malformation. (Courtesy of Gary Duckwiler, Los Angeles, Calif.) (d) On a CT scan, polyvinyl alcohol is difficult to see. If the patient undergoes imaging immediately after embolization, as in this case, the clot produced by polyvinyl alcohol may be seen as a linear area of increased attenuation (arrow).

View larger version (150K): [in a new window]   Figure 10d.  Intracranial embolic materials. (a) Frontal radiograph of the skull shows a platinum coil (arrow) in a small, distal middle cerebral artery branch. It does not look circular, because it has conformed to the shape of the artery. (b) Massive hemorrhage not controlled by surgery in a 61-year-old man who had undergone radiation therapy for unresectable squamous cancer of the neck. Frontal view from angiography shows that the right external carotid artery has been occluded by multiple platinum coils. (c) Lateral view from angiography shows cyanoacrylate glue (arrow) that occludes an arterial venous malformation. (Courtesy of Gary Duckwiler, Los Angeles, Calif.) (d) On a CT scan, polyvinyl alcohol is difficult to see. If the patient undergoes imaging immediately after embolization, as in this case, the clot produced by polyvinyl alcohol may be seen as a linear area of increased attenuation (arrow).

View larger version (142K): [in a new window]   Figure 11.  Aneurysm clips (same patient as in Fig 1). Frontal radiograph of the skull shows four aneurysm clips (black arrowheads) near the circle of Willis. There are also a right-sided CSF shunt (black arrows), scalp (skin) staples (white arrowheads), left craniotomy fixation plugs (*), and dental fillings.

View larger version (148K): [in a new window]   Figure 12.  CT scan shows intracranial brachytherapy catheters (arrow). They have a low radiodensity because they have not yet been loaded with radioactive seeds and are filled with air.

View larger version (159K): [in a new window]   Figure 13a.  Intracranial balloon system in a 41-year-old woman treated for glioblastoma multiforme. Lateral radiograph of the skull (a) and CT scan (b) of the cranium show an intracranial balloon system (GliaSite balloon; Proxima Therapeutics, Alpharetta, Ga) for the installation of radioactive iodine. In a, note the scalp (skin) staples and the cranial bone staples from recent intracranial surgery. In b, note the polymer wafer (arrow) impregnated with carmustine (BCNU), which shows up only as a thin white line because of its small size (1.45-cm diameter, 1-mm thickness).

View larger version (145K): [in a new window]   Figure 13b.  Intracranial balloon system in a 41-year-old woman treated for glioblastoma multiforme. Lateral radiograph of the skull (a) and CT scan (b) of the cranium show an intracranial balloon system (GliaSite balloon; Proxima Therapeutics, Alpharetta, Ga) for the installation of radioactive iodine. In a, note the scalp (skin) staples and the cranial bone staples from recent intracranial surgery. In b, note the polymer wafer (arrow) impregnated with carmustine (BCNU), which shows up only as a thin white line because of its small size (1.45-cm diameter, 1-mm thickness).

View larger version (127K): [in a new window]   Figure 14a.  Hearing aids. (a) Lateral radiograph of the cervical spine shows a hearing aid with a behind-the-ear compartment containing a battery (arrow), microphone, and amplifier. The ear mold has been removed. (b) Oblique radiograph of the skull shows a right cochlear implant. Receiver/stimulator (arrows) may look like an external hearing aid at radiography. (c) Cranial CT scan of the same patient as in b shows the cochlear implant. The receiver/stimulator (large arrow) lies in a groove cut into the mastoid portion of the temporal bone. The wire leaving the receiver/stimulator (small arrow) passes into the cochlea and forms the electrodes. The metallic portion of the cochlear apparatus is not seen because it lies in a different plane. (Courtesy of Steve Bessen, MD, Las Vegas, Nev.)

View larger version (122K): [in a new window]   Figure 14b.  Hearing aids. (a) Lateral radiograph of the cervical spine shows a hearing aid with a behind-the-ear compartment containing a battery (arrow), microphone, and amplifier. The ear mold has been removed. (b) Oblique radiograph of the skull shows a right cochlear implant. Receiver/stimulator (arrows) may look like an external hearing aid at radiography. (c) Cranial CT scan of the same patient as in b shows the cochlear implant. The receiver/stimulator (large arrow) lies in a groove cut into the mastoid portion of the temporal bone. The wire leaving the receiver/stimulator (small arrow) passes into the cochlea and forms the electrodes. The metallic portion of the cochlear apparatus is not seen because it lies in a different plane. (Courtesy of Steve Bessen, MD, Las Vegas, Nev.)

View larger version (118K): [in a new window]   Figure 14c.  Hearing aids. (a) Lateral radiograph of the cervical spine shows a hearing aid with a behind-the-ear compartment containing a battery (arrow), microphone, and amplifier. The ear mold has been removed. (b) Oblique radiograph of the skull shows a right cochlear implant. Receiver/stimulator (arrows) may look like an external hearing aid at radiography. (c) Cranial CT scan of the same patient as in b shows the cochlear implant. The receiver/stimulator (large arrow) lies in a groove cut into the mastoid portion of the temporal bone. The wire leaving the receiver/stimulator (small arrow) passes into the cochlea and forms the electrodes. The metallic portion of the cochlear apparatus is not seen because it lies in a different plane. (Courtesy of Steve Bessen, MD, Las Vegas, Nev.)

View larger version (121K): [in a new window]   Figure 15a.  Orbital prostheses and silicone oil. (a) Radiograph shows an hydroxyapatite orbital prosthesis. The prosthesis is designed for the insertion of a glass eye, and the intraocular muscles can be attached to provide proper motion of the prosthetic system in concert with the motion of the other eye. (b) CT scan shows a right ocular prosthesis. (c) CT scan shows silicone oil installed in the left eye for treatment of retinal detachment.

View larger version (131K): [in a new window]   Figure 15b.  Orbital prostheses and silicone oil. (a) Radiograph shows an hydroxyapatite orbital prosthesis. The prosthesis is designed for the insertion of a glass eye, and the intraocular muscles can be attached to provide proper motion of the prosthetic system in concert with the motion of the other eye. (b) CT scan shows a right ocular prosthesis. (c) CT scan shows silicone oil installed in the left eye for treatment of retinal detachment.

View larger version (137K): [in a new window]   Figure 15c.  Orbital prostheses and silicone oil. (a) Radiograph shows an hydroxyapatite orbital prosthesis. The prosthesis is designed for the insertion of a glass eye, and the intraocular muscles can be attached to provide proper motion of the prosthetic system in concert with the motion of the other eye. (b) CT scan shows a right ocular prosthesis. (c) CT scan shows silicone oil installed in the left eye for treatment of retinal detachment.

View larger version (105K): [in a new window]   Figure 16a.  (a) Anterior cervical fixation plate with prefabricated bone allograft that failed to fuse. Lateral radiograph shows radiolucency around the allograft. The somewhat anterior position of the allograft and plate is typical for these plates, and it is not subluxed from its original placement position. (b) Oblique radiograph of a 27-year-old woman who had a tumor resected from the upper thoracic spine demonstrates Steffee plates and screws that were placed for spinal stabilization. Gold foil (arrows) was inserted to protect the spinal cord when the patient underwent radiation therapy.

View larger version (118K): [in a new window]   Figure 16b.  (a) Anterior cervical fixation plate with prefabricated bone allograft that failed to fuse. Lateral radiograph shows radiolucency around the allograft. The somewhat anterior position of the allograft and plate is typical for these plates, and it is not subluxed from its original placement position. (b) Oblique radiograph of a 27-year-old woman who had a tumor resected from the upper thoracic spine demonstrates Steffee plates and screws that were placed for spinal stabilization. Gold foil (arrows) was inserted to protect the spinal cord when the patient underwent radiation therapy.

View larger version (97K): [in a new window]   Figure 17a.  Posterior cervical spine wiring. Frontal (a) and lateral (b) radiographs of the cervical spine show posterior cervical wires from C-4 to C-7 after laminectomy. The lateral view was obtained after cervical myelography.

View larger version (103K): [in a new window]   Figure 17b.  Posterior cervical spine wiring. Frontal (a) and lateral (b) radiographs of the cervical spine show posterior cervical wires from C-4 to C-7 after laminectomy. The lateral view was obtained after cervical myelography.

View larger version (140K): [in a new window]   Figure 18a.  Odontoid fracture fixation. (a) Lateral radiograph of the cervical spine obtained after surgery shows fixation of an odontoid base fracture by an odontoid screw and a sublaminar wire between C-1 and C-2. Note the surgical drain in the posterior aspect of the neck, the gown snaps, and dental fillings. (b, c) Frontal (b) and lateral (c) radiographs of the cervical spine in a patient with rheumatoid arthritis show an occipital-spinal strut with posterior wiring used to stabilize the cervical spine and subluxation of C-1 to C-2. There is vertebral body ankylosis (arrows in c) from the rheumatoid arthritis.

View larger version (142K): [in a new window]   Figure 18b.  Odontoid fracture fixation. (a) Lateral radiograph of the cervical spine obtained after surgery shows fixation of an odontoid base fracture by an odontoid screw and a sublaminar wire between C-1 and C-2. Note the surgical drain in the posterior aspect of the neck, the gown snaps, and dental fillings. (b, c) Frontal (b) and lateral (c) radiographs of the cervical spine in a patient with rheumatoid arthritis show an occipital-spinal strut with posterior wiring used to stabilize the cervical spine and subluxation of C-1 to C-2. There is vertebral body ankylosis (arrows in c) from the rheumatoid arthritis.

View larger version (138K): [in a new window]   Figure 18c.  Odontoid fracture fixation. (a) Lateral radiograph of the cervical spine obtained after surgery shows fixation of an odontoid base fracture by an odontoid screw and a sublaminar wire between C-1 and C-2. Note the surgical drain in the posterior aspect of the neck, the gown snaps, and dental fillings. (b, c) Frontal (b) and lateral (c) radiographs of the cervical spine in a patient with rheumatoid arthritis show an occipital-spinal strut with posterior wiring used to stabilize the cervical spine and subluxation of C-1 to C-2. There is vertebral body ankylosis (arrows in c) from the rheumatoid arthritis.

View larger version (111K): [in a new window]   Figure 19a.  Halo vest and brace. (a, b) Frontal (a) and lateral (b) views of a halo vest and brace. Four metallic uprights connect the halo ring around the skull to the vest. (c, d) Frontal (c) and lateral (d) radiographs of the skull show head tongs used to stabilize the head and neck in a patient with a cervical spine fracture. One or more screws penetrate the outer table of the skull on each side. They are connected to each other by horizontal or vertical bars on each side that are attached to an external traction device.

View larger version (112K): [in a new window]   Figure 19b.  Halo vest and brace. (a, b) Frontal (a) and lateral (b) views of a halo vest and brace. Four metallic uprights connect the halo ring around the skull to the vest. (c, d) Frontal (c) and lateral (d) radiographs of the skull show head tongs used to stabilize the head and neck in a patient with a cervical spine fracture. One or more screws penetrate the outer table of the skull on each side. They are connected to each other by horizontal or vertical bars on each side that are attached to an external traction device.

View larger version (156K): [in a new window]   Figure 19c.  Halo vest and brace. (a, b) Frontal (a) and lateral (b) views of a halo vest and brace. Four metallic uprights connect the halo ring around the skull to the vest. (c, d) Frontal (c) and lateral (d) radiographs of the skull show head tongs used to stabilize the head and neck in a patient with a cervical spine fracture. One or more screws penetrate the outer table of the skull on each side. They are connected to each other by horizontal or vertical bars on each side that are attached to an external traction device.

View larger version (113K): [in a new window]   Figure 19d.  Halo vest and brace. (a, b) Frontal (a) and lateral (b) views of a halo vest and brace. Four metallic uprights connect the halo ring around the skull to the vest. (c, d) Frontal (c) and lateral (d) radiographs of the skull show head tongs used to stabilize the head and neck in a patient with a cervical spine fracture. One or more screws penetrate the outer table of the skull on each side. They are connected to each other by horizontal or vertical bars on each side that are attached to an external traction device.

View larger version (93K): [in a new window]   Figure 20.  Bilateral Luque rods. Frontal radiograph shows bilateral Luque rods that were placed to stabilize the spine for treatment of scoliosis. Note the rod fractures at the T-12 level.

View larger version (138K): [in a new window]   Figure 21.  Hartshill rectangle used to treat degenerative disease in the lower lumbar spine. Frontal radiograph shows a Hartshill rectangle with surrounding bone fusion. The wires through the sacral lamina are broken, which is not a problem if there is solid bone fusion.

View larger version (153K): [in a new window]   Figure 22a.  Frontal (a) and lateral (b) radiographs of the lower thoracic spine show Wisconsin posterior spinal wiring. The wires go under the lamina and are connected to buttons that sit external to the posterior elements of the spine.

View larger version (143K): [in a new window]   Figure 22b.  Frontal (a) and lateral (b) radiographs of the lower thoracic spine show Wisconsin posterior spinal wiring. The wires go under the lamina and are connected to buttons that sit external to the posterior elements of the spine.

View larger version (37K): [in a new window]   Figure 23a.  Harrington rods for posterior spinal fixation. (a) Photograph of Harrington rods shows their flanged ends and hooks. The hooks on these particular rods are designed for distraction. (b) Lateral radiograph of the thoracolumbar junction shows a Harrington rod stabilizing a vertebral body fracture. Hooks (thick arrows) are used to anchor the rod ends in the lamina. Segmental wires around the lamina (thin arrow) also augment the fixation.

View larger version (118K): [in a new window]   Figure 23b.  Harrington rods for posterior spinal fixation. (a) Photograph of Harrington rods shows their flanged ends and hooks. The hooks on these particular rods are designed for distraction. (b) Lateral radiograph of the thoracolumbar junction shows a Harrington rod stabilizing a vertebral body fracture. Hooks (thick arrows) are used to anchor the rod ends in the lamina. Segmental wires around the lamina (thin arrow) also augment the fixation.

View larger version (156K): [in a new window]   Figure 24a.  Brantigan interbody vertebral cage. (a, b) Frontal (a) and lateral (b) radiographs of the lumbar spine in two different patients show a laminectomy from L-2 to S-1. There are bilateral Steffee pedicle plates and screws at L-2 to L-4 with two side-by-side high-density carbon fiber Brantigan interbody vertebral cages (arrows) at L-2 to L-3. (c) Photograph of a Brantigan interbody vertebral cage shows its grooves for bone incorporation into the vertebrae and a metallic marker (arrow) for identification on radiographs.

View larger version (155K): [in a new window]   Figure 24b.  Brantigan interbody vertebral cage. (a, b) Frontal (a) and lateral (b) radiographs of the lumbar spine in two different patients show a laminectomy from L-2 to S-1. There are bilateral Steffee pedicle plates and screws at L-2 to L-4 with two side-by-side high-density carbon fiber Brantigan interbody vertebral cages (arrows) at L-2 to L-3. (c) Photograph of a Brantigan interbody vertebral cage shows its grooves for bone incorporation into the vertebrae and a metallic marker (arrow) for identification on radiographs.

View larger version (87K): [in a new window]   Figure 24c.  Brantigan interbody vertebral cage. (a, b) Frontal (a) and lateral (b) radiographs of the lumbar spine in two different patients show a laminectomy from L-2 to S-1. There are bilateral Steffee pedicle plates and screws at L-2 to L-4 with two side-by-side high-density carbon fiber Brantigan interbody vertebral cages (arrows) at L-2 to L-3. (c) Photograph of a Brantigan interbody vertebral cage shows its grooves for bone incorporation into the vertebrae and a metallic marker (arrow) for identification on radiographs.

View larger version (122K): [in a new window]   Figure 25a.  Frontal (a) and lateral (b) radiographs of the lumbar spine show pedicle screws at L-3 and L-5 with spanning rods on each side. There is an anterior allograft bone strut used to treat metastatic neuroblastoma in the L-4 vertebral body. Note the bone strut crosses both the pathologic vertebral body as well as its adjacent disks. The anterior position of the bone strut is typical for these struts, and it does not represent migration after surgery.

View larger version (91K): [in a new window]   Figure 25b.  Frontal (a) and lateral (b) radiographs of the lumbar spine show pedicle screws at L-3 and L-5 with spanning rods on each side. There is an anterior allograft bone strut used to treat metastatic neuroblastoma in the L-4 vertebral body. Note the bone strut crosses both the pathologic vertebral body as well as its adjacent disks. The anterior position of the bone strut is typical for these struts, and it does not represent migration after surgery.

View larger version (139K): [in a new window]   Figure 26a.  Harms vertebral body cage. Frontal (a) and lateral (b) radiographs of the lower thoracic spine show a Harms vertebral body cage and a side plate and screws used to treat a spinal tumor.

View larger version (156K): [in a new window]   Figure 26b.  Harms vertebral body cage. Frontal (a) and lateral (b) radiographs of the lower thoracic spine show a Harms vertebral body cage and a side plate and screws used to treat a spinal tumor.

View larger version (147K): [in a new window]   Figure 27.  Frontal radiograph shows two Bagby and Kuslich threaded screw-in metallic vertebral cages that were used to treat degenerative lumbar spine disease.

View larger version (132K): [in a new window]   Figure 28.  Lateral radiograph of the lumbar spine in a 75-year-old woman with osteoporosis shows vertebroplasty. The patient had experienced severe back pain after lifting a heavy bag and had sustained a fracture. Vertebroplasty was performed at L-3 to relieve unremitting pain caused by the compression fracture.

View larger version (60K): [in a new window]   Figure 29a.  Spinal column treatment devices in different patients. (a, b) Frontal (a) and lateral (b) radiographs show the presence of a dorsal column stimulation unit in the upper cervical spine. Skin staples from the recent surgery are seen, and there is congenital fusion of the C-5 and C-6 vertebral bodies. (c) Frontal radiograph of the lumbar spine in another patient shows a bone stimulator. Battery pack overlies the right 12th rib, and there are wires going to electrodes in the bony fusion masses bilaterally. A laminectomy had been performed from L-2 to S-1 with bilateral pedicle screws and a pedicle plate on the right and a connecting pedicle rod on the left. There are also two Brantigan vertebral cages at the L-5 to S-1 disk space. (d) Lateral radiograph of another patient shows an intrathecal drug delivery catheter (top arrow) that was placed in the lower thoracic subarachnoid space. The catheter goes down the spinal canal and exits to an anterior abdominal delivery pump, a portion of which (bottom arrow) is evident. (e, f) Frontal (e) and lateral (f) radiographs of the pelvis and sacrum in another patient show a sacral stimulator.

View larger version (108K): [in a new window]   Figure 29b.  Spinal column treatment devices in different patients. (a, b) Frontal (a) and lateral (b) radiographs show the presence of a dorsal column stimulation unit in the upper cervical spine. Skin staples from the recent surgery are seen, and there is congenital fusion of the C-5 and C-6 vertebral bodies. (c) Frontal radiograph of the lumbar spine in another patient shows a bone stimulator. Battery pack overlies the right 12th rib, and there are wires going to electrodes in the bony fusion masses bilaterally. A laminectomy had been performed from L-2 to S-1 with bilateral pedicle screws and a pedicle plate on the right and a connecting pedicle rod on the left. There are also two Brantigan vertebral cages at the L-5 to S-1 disk space. (d) Lateral radiograph of another patient shows an intrathecal drug delivery catheter (top arrow) that was placed in the lower thoracic subarachnoid space. The catheter goes down the spinal canal and exits to an anterior abdominal delivery pump, a portion of which (bottom arrow) is evident. (e, f) Frontal (e) and lateral (f) radiographs of the pelvis and sacrum in another patient show a sacral stimulator.

View larger version (94K): [in a new window]   Figure 29c.  Spinal column treatment devices in different patients. (a, b) Frontal (a) and lateral (b) radiographs show the presence of a dorsal column stimulation unit in the upper cervical spine. Skin staples from the recent surgery are seen, and there is congenital fusion of the C-5 and C-6 vertebral bodies. (c) Frontal radiograph of the lumbar spine in another patient shows a bone stimulator. Battery pack overlies the right 12th rib, and there are wires going to electrodes in the bony fusion masses bilaterally. A laminectomy had been performed from L-2 to S-1 with bilateral pedicle screws and a pedicle plate on the right and a connecting pedicle rod on the left. There are also two Brantigan vertebral cages at the L-5 to S-1 disk space. (d) Lateral radiograph of another patient shows an intrathecal drug delivery catheter (top arrow) that was placed in the lower thoracic subarachnoid space. The catheter goes down the spinal canal and exits to an anterior abdominal delivery pump, a portion of which (bottom arrow) is evident. (e, f) Frontal (e) and lateral (f) radiographs of the pelvis and sacrum in another patient show a sacral stimulator.

View larger version (105K): [in a new window]   Figure 29d.  Spinal column treatment devices in different patients. (a, b) Frontal (a) and lateral (b) radiographs show the presence of a dorsal column stimulation unit in the upper cervical spine. Skin staples from the recent surgery are seen, and there is congenital fusion of the C-5 and C-6 vertebral bodies. (c) Frontal radiograph of the lumbar spine in another patient shows a bone stimulator. Battery pack overlies the right 12th rib, and there are wires going to electrodes in the bony fusion masses bilaterally. A laminectomy had been performed from L-2 to S-1 with bilateral pedicle screws and a pedicle plate on the right and a connecting pedicle rod on the left. There are also two Brantigan vertebral cages at the L-5 to S-1 disk space. (d) Lateral radiograph of another patient shows an intrathecal drug delivery catheter (top arrow) that was placed in the lower thoracic subarachnoid space. The catheter goes down the spinal canal and exits to an anterior abdominal delivery pump, a portion of which (bottom arrow) is evident. (e, f) Frontal (e) and lateral (f) radiographs of the pelvis and sacrum in another patient show a sacral stimulator.

View larger version (107K): [in a new window]   Figure 29e.  Spinal column treatment devices in different patients. (a, b) Frontal (a) and lateral (b) radiographs show the presence of a dorsal column stimulation unit in the upper cervical spine. Skin staples from the recent surgery are seen, and there is congenital fusion of the C-5 and C-6 vertebral bodies. (c) Frontal radiograph of the lumbar spine in another patient shows a bone stimulator. Battery pack overlies the right 12th rib, and there are wires going to electrodes in the bony fusion masses bilaterally. A laminectomy had been performed from L-2 to S-1 with bilateral pedicle screws and a pedicle plate on the right and a connecting pedicle rod on the left. There are also two Brantigan vertebral cages at the L-5 to S-1 disk space. (d) Lateral radiograph of another patient shows an intrathecal drug delivery catheter (top arrow) that was placed in the lower thoracic subarachnoid space. The catheter goes down the spinal canal and exits to an anterior abdominal delivery pump, a portion of which (bottom arrow) is evident. (e, f) Frontal (e) and lateral (f) radiographs of the pelvis and sacrum in another patient show a sacral stimulator.

View larger version (50K): [in a new window]   Figure 29f.  Spinal column treatment devices in different patients. (a, b) Frontal (a) and lateral (b) radiographs show the presence of a dorsal column stimulation unit in the upper cervical spine. Skin staples from the recent surgery are seen, and there is congenital fusion of the C-5 and C-6 vertebral bodies. (c) Frontal radiograph of the lumbar spine in another patient shows a bone stimulator. Battery pack overlies the right 12th rib, and there are wires going to electrodes in the bony fusion masses bilaterally. A laminectomy had been performed from L-2 to S-1 with bilateral pedicle screws and a pedicle plate on the right and a connecting pedicle rod on the left. There are also two Brantigan vertebral cages at the L-5 to S-1 disk space. (d) Lateral radiograph of another patient shows an intrathecal drug delivery catheter (top arrow) that was placed in the lower thoracic subarachnoid space. The catheter goes down the spinal canal and exits to an anterior abdominal delivery pump, a portion of which (bottom arrow) is evident. (e, f) Frontal (e) and lateral (f) radiographs of the pelvis and sacrum in another patient show a sacral stimulator.

View larger version (119K): [in a new window]   Figure 30a.  Dental devices. (a) Panoramic radiograph shows bone plates with screws (A) and bone ligature wires (B). Note also the multiple dental alloy restorations (amalgam fillings). (b) Panoramic radiograph shows root canal fillings with denture retention posts (A) and porcelain denture teeth with pins (B). (c) Frontal radiograph of the mandible shows a temporomandibular joint prosthetic condyle implant (A), orthodontic arch bars (B), porcelain veneer crowns (caps) (C), and fixation screws (bone screws) (D). (d) Radiograph shows a cubic zirconia crown (*). Note the opacity of the zirconia substrate. The zirconia is surrounded by porcelain (horizontal arrowheads). Note the endodontic root canal with gutta percha (arrows), a radiopaque rubber, in the tooth next to it. The light shade of the teeth (vertical arrowheads) next to the tooth containing the cubic zirconia crown shows that they have been restored with a composite acrylic restoration.

View larger version (143K): [in a new window]   Figure 30b.  Dental devices. (a) Panoramic radiograph shows bone plates with screws (A) and bone ligature wires (B). Note also the multiple dental alloy restorations (amalgam fillings). (b) Panoramic radiograph shows root canal fillings with denture retention posts (A) and porcelain denture teeth with pins (B). (c) Frontal radiograph of the mandible shows a temporomandibular joint prosthetic condyle implant (A), orthodontic arch bars (B), porcelain veneer crowns (caps) (C), and fixation screws (bone screws) (D). (d) Radiograph shows a cubic zirconia crown (*). Note the opacity of the zirconia substrate. The zirconia is surrounded by porcelain (horizontal arrowheads). Note the endodontic root canal with gutta percha (arrows), a radiopaque rubber, in the tooth next to it. The light shade of the teeth (vertical arrowheads) next to the tooth containing the cubic zirconia crown shows that they have been restored with a composite acrylic restoration.

View larger version (114K): [in a new window]   Figure 30c.  Dental devices. (a) Panoramic radiograph shows bone plates with screws (A) and bone ligature wires (B). Note also the multiple dental alloy restorations (amalgam fillings). (b) Panoramic radiograph shows root canal fillings with denture retention posts (A) and porcelain denture teeth with pins (B). (c) Frontal radiograph of the mandible shows a temporomandibular joint prosthetic condyle implant (A), orthodontic arch bars (B), porcelain veneer crowns (caps) (C), and fixation screws (bone screws) (D). (d) Radiograph shows a cubic zirconia crown (*). Note the opacity of the zirconia substrate. The zirconia is surrounded by porcelain (horizontal arrowheads). Note the endodontic root canal with gutta percha (arrows), a radiopaque rubber, in the tooth next to it. The light shade of the teeth (vertical arrowheads) next to the tooth containing the cubic zirconia crown shows that they have been restored with a composite acrylic restoration.

View larger version (121K): [in a new window]   Figure 30d.  Dental devices. (a) Panoramic radiograph shows bone plates with screws (A) and bone ligature wires (B). Note also the multiple dental alloy restorations (amalgam fillings). (b) Panoramic radiograph shows root canal fillings with denture retention posts (A) and porcelain denture teeth with pins (B). (c) Frontal radiograph of the mandible shows a temporomandibular joint prosthetic condyle implant (A), orthodontic arch bars (B), porcelain veneer crowns (caps) (C), and fixation screws (bone screws) (D). (d) Radiograph shows a cubic zirconia crown (*). Note the opacity of the zirconia substrate. The zirconia is surrounded by porcelain (horizontal arrowheads). Note the endodontic root canal with gutta percha (arrows), a radiopaque rubber, in the tooth next to it. The light shade of the teeth (vertical arrowheads) next to the tooth containing the cubic zirconia crown shows that they have been restored with a composite acrylic restoration.

View larger version (126K): [in a new window]   Figure 31a.  Gastric and tracheal tubes. (a) Lateral radiograph of the head and neck in a child with severe intracranial and cervical spine injuries shows the presence of bilateral cranial stabilization tongs, an endotracheal tube, a nasogastric tube, and a feeding tube (entering via the nose). (b, c) Frontal (b) and lateral (c) radiographs of the chest and neck in a different patient show the incorrect placement of a tracheostomy tube. The tip of the tube is to the left of the trachea in b and anterior to the trachea (arrow) in c. (d) Nasotracheal and orogastric tubes. Lateral radiograph shows a nasotracheal tube that is larger and anterior in the expected location of the trachea. The orogastric tube is smaller (arrow) and posterior.

View larger version (104K): [in a new window]   Figure 31b.  Gastric and tracheal tubes. (a) Lateral radiograph of the head and neck in a child with severe intracranial and cervical spine injuries shows the presence of bilateral cranial stabilization tongs, an endotracheal tube, a nasogastric tube, and a feeding tube (entering via the nose). (b, c) Frontal (b) and lateral (c) radiographs of the chest and neck in a different patient show the incorrect placement of a tracheostomy tube. The tip of the tube is to the left of the trachea in b and anterior to the trachea (arrow) in c. (d) Nasotracheal and orogastric tubes. Lateral radiograph shows a nasotracheal tube that is larger and anterior in the expected location of the trachea. The orogastric tube is smaller (arrow) and posterior.

View larger version (123K): [in a new window]   Figure 31c.  Gastric and tracheal tubes. (a) Lateral radiograph of the head and neck in a child with severe intracranial and cervical spine injuries shows the presence of bilateral cranial stabilization tongs, an endotracheal tube, a nasogastric tube, and a feeding tube (entering via the nose). (b, c) Frontal (b) and lateral (c) radiographs of the chest and neck in a different patient show the incorrect placement of a tracheostomy tube. The tip of the tube is to the left of the trachea in b and anterior to the trachea (arrow) in c. (d) Nasotracheal and orogastric tubes. Lateral radiograph shows a nasotracheal tube that is larger and anterior in the expected location of the trachea. The orogastric tube is smaller (arrow) and posterior.

View larger version (162K): [in a new window]   Figure 31d.  Gastric and tracheal tubes. (a) Lateral radiograph of the head and neck in a child with severe intracranial and cervical spine injuries shows the presence of bilateral cranial stabilization tongs, an endotracheal tube, a nasogastric tube, and a feeding tube (entering via the nose). (b, c) Frontal (b) and lateral (c) radiographs of the chest and neck in a different patient show the incorrect placement of a tracheostomy tube. The tip of the tube is to the left of the trachea in b and anterior to the trachea (arrow) in c. (d) Nasotracheal and orogastric tubes. Lateral radiograph shows a nasotracheal tube that is larger and anterior in the expected location of the trachea. The orogastric tube is smaller (arrow) and posterior.

View larger version (121K): [in a new window]   Figure 32a.  Vagus nerve stimulator. Frontal (a) and lateral (b) radiographs of the neck show a left vagus nerve stimulator used to treat intractable epilepsy.

View larger version (121K): [in a new window]   Figure 32b.  Vagus nerve stimulator. Frontal (a) and lateral (b) radiographs of the neck show a left vagus nerve stimulator used to treat intractable epilepsy.

View larger version (138K): [in a new window]   Figure 33.  Frontal radiograph of a 45-year-old woman with pseudotumor cerebri shows two "lumboperitoneal" shunts in place. The inferior shunt tip overlies the L-4 to L-5 level (bottom arrowheads). The superior shunt (top arrowheads) is seen here; its tip goes into the thoracic region and is not pictured on this view of the lumbar spine.

View larger version (129K): [in a new window]   Figure 34.  Lateral radiograph of the neck shows an esophageal temperature probe. There is also a probable pulse oximeter probe on one of the earlobes, an endotracheal tube, and an anterior cervical fixation plate.