Assessment of Pseudarthrosis in Pedicle Screw Fusion

Larsen, John M.; Rimoldi, Reynold L.; Capen, Daniel A.; Nelson, Russell W.; Nagelberg, Steven; Thomas, James C.

doi:10.1097/00002517-199604000-00005

Cited by 83 publications

(18 citation statements)

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“…Strengths are the homogeneous patient population in clinical assessment, age and gender and the standardized dedicated radiological approach. The sample size was comparable to earlier studies [9,13]. Kappa values were stable in either dichotomy with relatively narrow confidence intervals.…”

Section: Discussionsupporting

confidence: 73%

“…Thinsliced helical CT scans showed greater interobserver agreement and better illustration of bony bridging than static or bending radiographs [4,[8][9][10][11][12]. Comparison of either modality with surgical inspection documented not much agreement for plain radiographs [13] and posterolateral fusions on dedicated fine-cut CT were found moderately predictive of a solid fusion on surgical exploration [5]. The development of multidetector CT (MDCT) and dedicated protocols made it possible to minimize metallic artifacts [14,15] and allowed for isotropic coronal and sagittal reconstruction.…”

Section: Introductionmentioning

confidence: 99%

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Interobserver agreement in fusion status assessment after instrumental desis of the lower lumbar spine using 64-slice multidetector computed tomography: impact of observer experience

et al. 2012

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Purpose Persistent lower back pain after instrumental posterolateral desis may arise from incomplete fusion. We investigate the impact of experience on interobserver agreement in fusion estimation. Methods Four independent observers, two residents and two musculoskeletal radiologists, reviewed dedicated lumbar 64-MDCT scans and scored vertebral levels 1-5 after Glassman's grades, 1: solid bilateral fusion, 2: solid unilateral fusion, 3: partial bilateral fusion, 4: partial unilateral fusion, 5: non-fusion. We investigated two simplifying dichotomizations, solid bilateral fusion (Glassman 1) versus all others and uni-or bilateral fusion (Glassman 1-2) versus partial or non-fusion. Results Thirty-six patients with 61 operated lumbar levels were included. Interobserver agreement rates for four observers using Glassman's system were fair (kappa 0.32), either dichotomization showed moderate agreement (kappa 0.53 and 0.59). Observer pairs had comparable prevalence adjusted interobserver agreement rates (residents: PABAK 0.67 and 0.54; consultants: PABAK 0.57 and 0.71). Conclusions Difference in observer experience seems of minor impact.

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Interobserver agreement in fusion status assessment after instrumental desis of the lower lumbar spine using 64-slice multidetector computed tomography: impact of observer experience

et al. 2012

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“…Radiography however is dreadfully unreliable in detecting non-union (its accuracy ranges from 82%-68% [44,45] ) when compared to surgical exploration. Flexion-extension views may be helpful in detecting instability in the fused segments, although their value in the lumbar spine has been questioned [46,47] . Helical CT scanning has demonstrated better accuracy [48,49] although surgical exploration remains the "gold standard" [50] .…”

Section: Pseudarthrosis (Non-union)mentioning

confidence: 99%

Common surgical complications in degenerative spinal surgery

Papadakis¹

2013

WJO

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The rapid growth of spine degenerative surgery has led to unrelenting efforts to define and prevent possible complications, the incidence of which is probably higher than that reported and varies according to the region of the spine involved (cervical and thoracolumbar) and the severity of the surgery. Several issues are becoming progressively clearer, such as complication rates in primary versus revision spinal surgery, complications in the elderly, the contribution of minimally invasive surgery to the reduction of complication rate. In this paper the most common surgical complications in degenerative spinal surgery are outlined and discussed.

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“…Despite advances in imaging quality, radiographs at best are only two dimensional and dynamic radiographs though helpful in ruling out instability have their own limitations. The main shortcoming of dynamic x-rays includes measurement reliability and disagreement between observers on permissible motion [14]. Computed tomography (CT) is more sensitive in detecting non-union and is investigation of choice to confirm or rule out pseudarthrosis [15].…”

Section: Discussionmentioning

confidence: 99%

Surgical results with the use of Silicated Calcium Phosphate (SiCaP) as bone graft substitute in Posterior Spinal Fusion (PSF) for Adolescent Idiopathic Scoliosis (AIS)

Harshavardhana

Noordeen

2015

Scoliosis

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BackgroundThe gold standard iliac crest bone graft (ICBG) used to achieve arthrodesis in spinal fusions is not without complications (donor-site morbidity, iliac wing fractures etc.…). Our objectives were to evaluate the role of silicated calcium phosphate (SiCaP), an osteoconductive synthetic bone graft substitute in conjunction with locally harvested autologous bone in achieving arthrodesis following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and report clinic-radiological results / adverse events with its use in a prospective single surgeon case series (Level of evidence [LoE] IV) treated by low implant density index (IDI) constructs (i.e., IDI ≤1.5).MethodsThirty-five patients (8♂ & 2727♀) who underwent PSF and followed-up for a minimum of 2 years formed the study cohort. The mean age at surgery was 15 years (range: 11–21y) and pre-op Cobb angle was 60° (range: 40°–90°). SiCaP mixed with locally harvested bone during exposure and instrumentation was laid over instrumented segments. The average SiCaP used per patient was 32mls (range: 10–60mls). Radiographs were assessed for fusion at serial six monthly follow-ups. All clinical adverse events and complications were recorded.ResultsThe mean follow-up was 2.94 years (range: 2–4y). The post-op Cobb angle improved to 23° (range: 2°– 55°) and the mean in-patient stay was 7.72 days (range: 5–13d). The mean number of instrumented segments was 9.4 (range: 4–13) and implant density index (IDI) averaged 1.23 (range: 1.15–1.5). Radiographic new bone formation was seen within 3 months in all cases. All patients (except two) were highly satisfied at minimum follow-up of 8 years. There were two complications warranting revision surgery (deep infection, and implant failure without any evidence of pseudarthrosis). There were no SiCaP specific adverse events in any of the 35 patients.ConclusionSiCaP facilitated early bony consolidation in operated cohort of AIS patients treated by PSF. There were no inflammatory reaction or other adverse effects associated with its use. SiCaP is a safe alternative to autologous iliac crest bone graft with reduced complications, morbidity, faster recovery and similar infection/fusion rates reported in the literature.

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Assessment of Pseudarthrosis in Pedicle Screw Fusion

Cited by 83 publications

References 0 publications

Interobserver agreement in fusion status assessment after instrumental desis of the lower lumbar spine using 64-slice multidetector computed tomography: impact of observer experience

Interobserver agreement in fusion status assessment after instrumental desis of the lower lumbar spine using 64-slice multidetector computed tomography: impact of observer experience

Common surgical complications in degenerative spinal surgery

Surgical results with the use of Silicated Calcium Phosphate (SiCaP) as bone graft substitute in Posterior Spinal Fusion (PSF) for Adolescent Idiopathic Scoliosis (AIS)

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