{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:33:39Z","timestamp":1769726019857,"version":"3.49.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"11","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,9,15]]},"abstract":"\n BACKGROUND<\/jats:title>\n 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 \u201cpseudofractures,\u201d can distort imaging interpretation and result in unnecessary revision surgery.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 65-year-old male sustained a T12\u2013L1 fracture extending through the disc space with ligamentous interruption after a bicycle accident. The patient underwent T11\u2013L2 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.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n 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.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25358<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25358","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:26:38Z","timestamp":1758587198000},"source":"Crossref","is-referenced-by-count":0,"title":["Metal artifact reduction leading to appearance of fractures in pedicle screws: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Trevor","family":"Leon","sequence":"first","affiliation":[{"name":"Wright State University Boonshoft School of Medicine, Fairborn, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6278-8484","authenticated-orcid":true,"given":"Witty","family":"Kwok","sequence":"additional","affiliation":[{"name":"Wright State University Boonshoft School of Medicine, Fairborn, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Lindsay","sequence":"additional","affiliation":[{"name":"Wright State University Boonshoft School of Medicine, Fairborn, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8672-1831","authenticated-orcid":true,"given":"Marcelo","family":"Costa","sequence":"additional","affiliation":[{"name":"Wright State University Boonshoft School of Medicine, Fairborn, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brittany","family":"Staarmann","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Premier Health Miami Valley Hospital, Dayton, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Spine J","first-page":"461","article-title":"Value of standard radiographs, computed tomography, and magnetic resonance imaging of the lumbar spine in detection of intraoperatively confirmed pedicle screw loosening\u2014a prospective clinical trial","volume":"19","author":"Spirig","year":"2019","unstructured":"Spirig JMSutter RG\u00f6tschi TFarshad-Amacker NAFarshad M.Value of standard radiographs, computed tomography, and magnetic resonance imaging of the lumbar spine in detection of intraoperatively confirmed pedicle screw loosening\u2014a prospective clinical trial. Spine J. 2019;19(3):461-468."},{"issue":"4","key":"bib2","series-title":"Neurosurg Rev","first-page":"2163","article-title":"Carbon fiber-reinforced PEEK versus titanium implants: an in vitro comparison of susceptibility artifacts in CT and MR imaging","volume":"44","author":"Kr\u00e4tzig","year":"2021","unstructured":"Kr\u00e4tzig TMende KCMohme MCarbon fiber-reinforced PEEK versus titanium implants: an in vitro comparison of susceptibility artifacts in CT and MR imaging. Neurosurg Rev. 2021;44(4):2163-2170."},{"issue":"11","key":"bib3","series-title":"AJNR Am J Neuroradiol","first-page":"1973","article-title":"Unintended consequences: review of new artifacts introduced by iterative reconstruction CT metal artifact reduction in spine imaging","volume":"40","author":"Wayer","year":"2019","unstructured":"Wayer DRKim NYOtto BJGrayev AMKuner AD.Unintended consequences: review of new artifacts introduced by iterative reconstruction CT metal artifact reduction in spine imaging. AJNR Am J Neuroradiol. 2019;40(11):1973-1975."},{"issue":"2","key":"bib4","series-title":"RadioGraphics","first-page":"450","article-title":"Current and novel techniques for metal artifact reduction at CT: practical guide for radiologists","volume":"38","author":"Katsura","year":"2018","unstructured":"Katsura MSato JAkahane MKunimatsu AAbe O.Current and novel techniques for metal artifact reduction at CT: practical guide for radiologists. RadioGraphics. 2018;38(2):450-461."},{"issue":"6","key":"bib5","series-title":"J Appl Clin Med Phys","first-page":"198","article-title":"The application of metal artifact reduction methods on computed tomography scans for radiotherapy applications: a literature review","volume":"22","author":"Puvanasunthararajah","year":"2021","unstructured":"Puvanasunthararajah SFontanarosa DWille MLCamps SM.The application of metal artifact reduction methods on computed tomography scans for radiotherapy applications: a literature review. J Appl Clin Med Phys. 2021;22(6):198-223."},{"issue":"4","key":"bib6","series-title":"J Comput Assist Tomogr","first-page":"675","article-title":"The clinical value of the MAR+ metal artifact reduction algorithm for postoperative assessment of lumbar internal fixation","volume":"49","author":"Fang","year":"2025","unstructured":"Fang JYu FYang BWang GSi G.The clinical value of the MAR+ metal artifact reduction algorithm for postoperative assessment of lumbar internal fixation. J Comput Assist Tomogr. 2025;49(4):675-681."},{"issue":"4","key":"bib7","series-title":"J Clin Orthop Trauma","first-page":"645","article-title":"Chimera of digital radiography in spine surgery: false diagnosis of implant failure","volume":"10","author":"Salem","year":"2019","unstructured":"Salem KHLadenburger ASchoth FOhnsorge JA.Chimera of digital radiography in spine surgery: false diagnosis of implant failure. J Clin Orthop Trauma. 2019;10(4):645-649."},{"issue":"3","key":"bib8","series-title":"Semin Musculoskelet Radiol","first-page":"243","article-title":"Metal artifact reduction in musculoskeletal imaging with MR and CT","volume":"15","author":"Schweitzer","year":"2011","unstructured":"Schweitzer MEOuellette HMorrison WBMetal artifact reduction in musculoskeletal imaging with MR and CT. Semin Musculoskelet Radiol. 2011;15(3):243-256."},{"issue":"6","key":"bib9","series-title":"Radiographics","first-page":"1679","article-title":"Artifacts in CT: recognition and avoidance","volume":"24","author":"Barrett","year":"2004","unstructured":"Barrett JFKeat N.Artifacts in CT: recognition and avoidance. Radiographics. 2004;24(6):1679-1691."},{"issue":"1","key":"bib10","series-title":"Diagnostics (Basel)","first-page":"108","article-title":"Pedicle screw pseudofracture on computed tomography secondary to metal artifact reduction","volume":"14","author":"Ge","year":"2024","unstructured":"Ge SKumar NHallinan JTPD.Pedicle screw pseudofracture on computed tomography secondary to metal artifact reduction. Diagnostics (Basel). 2024;14(1):108."},{"issue":"9","key":"bib11","series-title":"Acta Radiol","first-page":"1110","article-title":"Metal artifact reduction in CT, a phantom study: subjective and objective evaluation of four commercial metal artifact reduction algorithms when used on three different orthopedic metal implants","volume":"59","author":"Bolstad","year":"2018","unstructured":"Bolstad KFlatab\u00f8 SAadnevik DDalehaug IVetti N.Metal artifact reduction in CT, a phantom study: subjective and objective evaluation of four commercial metal artifact reduction algorithms when used on three different orthopedic metal implants. Acta Radiol. 2018;59(9):1110-1118."},{"issue":"3","key":"bib12","series-title":"RadioGraphics","first-page":"791","article-title":"Overcoming artifacts from metallic orthopedic implants at high-field-strength MR imaging and multi-detector CT","volume":"27","author":"Lee","year":"2007","unstructured":"Lee MJKim SLee SAOvercoming artifacts from metallic orthopedic implants at high-field-strength MR imaging and multi-detector CT. RadioGraphics. 2007;27(3):791-803."},{"issue":"2","key":"bib13","series-title":"J Med Phys","first-page":"152","article-title":"Reduction of metal artifacts caused by titanium peduncular screws in the spine by means of monoenergetic images and the metal artifact reduction software in dual-energy computed tomography","volume":"47","author":"Ceccarelli","year":"2022","unstructured":"Ceccarelli LVara GPonti FMiceli MGolfieri RFacchini G.Reduction of metal artifacts caused by titanium peduncular screws in the spine by means of monoenergetic images and the metal artifact reduction software in dual-energy computed tomography. J Med Phys. 2022;47(2):152-158."},{"issue":"1","key":"bib14","series-title":"Sci Rep","first-page":"2211","article-title":"Metal artefact reduction of different alloys with dual energy computed tomography (DECT)","volume":"11","author":"Vellarackal","year":"2021","unstructured":"Vellarackal AJKaim AH.Metal artefact reduction of different alloys with dual energy computed tomography (DECT). Sci Rep. 2021;11(1):2211."},{"issue":"3","key":"bib1","series-title":"Spine J","first-page":"461","article-title":"Value of standard radiographs, computed tomography, and magnetic resonance imaging of the lumbar spine in detection of intraoperatively confirmed pedicle screw loosening\u2014a prospective clinical trial","volume":"19","author":"Spirig","year":"2019","unstructured":"Spirig JMSutter RG\u00f6tschi TFarshad-Amacker NAFarshad M.Value of standard radiographs, computed tomography, and magnetic resonance imaging of the lumbar spine in detection of intraoperatively confirmed pedicle screw loosening\u2014a prospective clinical trial. Spine J. 2019;19(3):461-468."},{"issue":"4","key":"bib2","series-title":"Neurosurg Rev","first-page":"2163","article-title":"Carbon fiber-reinforced PEEK versus titanium implants: an in vitro comparison of susceptibility artifacts in CT and MR imaging","volume":"44","author":"Kr\u00e4tzig","year":"2021","unstructured":"Kr\u00e4tzig TMende KCMohme MCarbon fiber-reinforced PEEK versus titanium implants: an in vitro comparison of susceptibility artifacts in CT and MR imaging. Neurosurg Rev. 2021;44(4):2163-2170."},{"issue":"11","key":"bib3","series-title":"AJNR Am J Neuroradiol","first-page":"1973","article-title":"Unintended consequences: review of new artifacts introduced by iterative reconstruction CT metal artifact reduction in spine imaging","volume":"40","author":"Wayer","year":"2019","unstructured":"Wayer DRKim NYOtto BJGrayev AMKuner AD.Unintended consequences: review of new artifacts introduced by iterative reconstruction CT metal artifact reduction in spine imaging. AJNR Am J Neuroradiol. 2019;40(11):1973-1975."},{"issue":"2","key":"bib4","series-title":"RadioGraphics","first-page":"450","article-title":"Current and novel techniques for metal artifact reduction at CT: practical guide for radiologists","volume":"38","author":"Katsura","year":"2018","unstructured":"Katsura MSato JAkahane MKunimatsu AAbe O.Current and novel techniques for metal artifact reduction at CT: practical guide for radiologists. RadioGraphics. 2018;38(2):450-461."},{"issue":"6","key":"bib5","series-title":"J Appl Clin Med Phys","first-page":"198","article-title":"The application of metal artifact reduction methods on computed tomography scans for radiotherapy applications: a literature review","volume":"22","author":"Puvanasunthararajah","year":"2021","unstructured":"Puvanasunthararajah SFontanarosa DWille MLCamps SM.The application of metal artifact reduction methods on computed tomography scans for radiotherapy applications: a literature review. J Appl Clin Med Phys. 2021;22(6):198-223."},{"issue":"4","key":"bib6","series-title":"J Comput Assist Tomogr","first-page":"675","article-title":"The clinical value of the MAR+ metal artifact reduction algorithm for postoperative assessment of lumbar internal fixation","volume":"49","author":"Fang","year":"2025","unstructured":"Fang JYu FYang BWang GSi G.The clinical value of the MAR+ metal artifact reduction algorithm for postoperative assessment of lumbar internal fixation. J Comput Assist Tomogr. 2025;49(4):675-681."},{"issue":"4","key":"bib7","series-title":"J Clin Orthop Trauma","first-page":"645","article-title":"Chimera of digital radiography in spine surgery: false diagnosis of implant failure","volume":"10","author":"Salem","year":"2019","unstructured":"Salem KHLadenburger ASchoth FOhnsorge JA.Chimera of digital radiography in spine surgery: false diagnosis of implant failure. J Clin Orthop Trauma. 2019;10(4):645-649."},{"issue":"3","key":"bib8","series-title":"Semin Musculoskelet Radiol","first-page":"243","article-title":"Metal artifact reduction in musculoskeletal imaging with MR and CT","volume":"15","author":"Schweitzer","year":"2011","unstructured":"Schweitzer MEOuellette HMorrison WBMetal artifact reduction in musculoskeletal imaging with MR and CT. Semin Musculoskelet Radiol. 2011;15(3):243-256."},{"issue":"6","key":"bib9","series-title":"Radiographics","first-page":"1679","article-title":"Artifacts in CT: recognition and avoidance","volume":"24","author":"Barrett","year":"2004","unstructured":"Barrett JFKeat N.Artifacts in CT: recognition and avoidance. Radiographics. 2004;24(6):1679-1691."},{"issue":"1","key":"bib10","series-title":"Diagnostics (Basel)","first-page":"108","article-title":"Pedicle screw pseudofracture on computed tomography secondary to metal artifact reduction","volume":"14","author":"Ge","year":"2024","unstructured":"Ge SKumar NHallinan JTPD.Pedicle screw pseudofracture on computed tomography secondary to metal artifact reduction. Diagnostics (Basel). 2024;14(1):108."},{"issue":"9","key":"bib11","series-title":"Acta Radiol","first-page":"1110","article-title":"Metal artifact reduction in CT, a phantom study: subjective and objective evaluation of four commercial metal artifact reduction algorithms when used on three different orthopedic metal implants","volume":"59","author":"Bolstad","year":"2018","unstructured":"Bolstad KFlatab\u00f8 SAadnevik DDalehaug IVetti N.Metal artifact reduction in CT, a phantom study: subjective and objective evaluation of four commercial metal artifact reduction algorithms when used on three different orthopedic metal implants. Acta Radiol. 2018;59(9):1110-1118."},{"issue":"3","key":"bib12","series-title":"RadioGraphics","first-page":"791","article-title":"Overcoming artifacts from metallic orthopedic implants at high-field-strength MR imaging and multi-detector CT","volume":"27","author":"Lee","year":"2007","unstructured":"Lee MJKim SLee SAOvercoming artifacts from metallic orthopedic implants at high-field-strength MR imaging and multi-detector CT. RadioGraphics. 2007;27(3):791-803."},{"issue":"2","key":"bib13","series-title":"J Med Phys","first-page":"152","article-title":"Reduction of metal artifacts caused by titanium peduncular screws in the spine by means of monoenergetic images and the metal artifact reduction software in dual-energy computed tomography","volume":"47","author":"Ceccarelli","year":"2022","unstructured":"Ceccarelli LVara GPonti FMiceli MGolfieri RFacchini G.Reduction of metal artifacts caused by titanium peduncular screws in the spine by means of monoenergetic images and the metal artifact reduction software in dual-energy computed tomography. J Med Phys. 2022;47(2):152-158."},{"issue":"1","key":"bib14","series-title":"Sci Rep","first-page":"2211","article-title":"Metal artefact reduction of different alloys with dual energy computed tomography (DECT)","volume":"11","author":"Vellarackal","year":"2021","unstructured":"Vellarackal AJKaim AH.Metal artefact reduction of different alloys with dual energy computed tomography (DECT). Sci Rep. 2021;11(1):2211."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/11\/article-CASE25358.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/11\/article-CASE25358.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/11\/article-CASE25358.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:09:23Z","timestamp":1769684963000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/11\/article-CASE25358.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,15]]},"references-count":28,"journal-issue":{"issue":"11"},"URL":"https:\/\/doi.org\/10.3171\/case25358","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,15]]}}}