Comparison of plain radiographs with CT scan to evaluate interbody fusion following the use of titanium interbody cages and transpedicular instrumentation

Shah, Rajesh R.; Saeed, Muhammad; Saifuddin, Asif; Taylor, Benjamin A.

doi:10.1007/s00586-002-0517-4

Cited by 116 publications

(58 citation statements)

References 27 publications

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“…This is in accord with the report of Shah et al [22] who compared plain radiography with CT imaging for evaluation of lumbar interbody fusion using titanium cages and transpedicular instrumentation and found near perfect agreement (kappa value 0.85) between two observers of the CT examinations. The latter is in contrast to the observer reliability of graft assessment using plain radiography as determined by Tuli et al [24].…”

Section: Grade II (Partial Fusion)supporting

confidence: 91%

CT-based classification of long spinal allograft fusion

et al. 2007

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Anterior column reconstruction of the thoracolumbar spine by structural allograft has an increased potential for biological fusion when compared to synthetic reconstructive options. Estimation of cortical union and trabecular in-growth is, however, traditionally based on plain radiography, a technique lacking in sensitivity. A new assessment method of bony union using high-speed spiral CT imaging is proposed which reflects the gradually increasing biological stability of the construct. Grade I (complete fusion) implies cortical union of the allograft and central trabecular continuity. Grade II (partial fusion) implies cortical union of the structural allograft with partial trabecular incorporation. Grade III (unipolar pseudarthrosis) denotes superior or inferior cortical non-union of the central allograft with partial trabecular discontinuity centrally and Grade IV (bipolar pseudarthrosis) suggests both superior and inferior cortical non-union with a complete lack of central trabecular continuity. Twenty-five patients underwent anterior spinal reconstruction for a single level burst fracture between T4 and L5. At a minimum of two years follow up the subjects underwent high-speed spiral CT scanning through the reconstructed region of the thoracolumbar spine. The classification showed satisfactory interobserver (kappa score = 0.91) and intraobserver (kappa score = 0.95) reliability. The use of high-speed CT imaging in the assessment of structural allograft union may allow a more accurate assessment of union. The classification system presented allows a reproducible categorization of allograft incorporation with implications for treatment.

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Section: Grade II (Partial Fusion)supporting

confidence: 91%

CT-based classification of long spinal allograft fusion

et al. 2007

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“…As the criteria to determine radiological fusion is not well defined and universally accepted, it is often difficult to arrive at a true assessment of fusion based on plain radiography particularly when interbody fusion cages are used. Fine-cut CT scans with reconstructions have been shown to be more reliable and sensitive for the detection of pseudarthrosis than plain radiography [5,23,24]. In the current study, the fusion status was assessed using fine-cut CT scans with reconstructions in addition to static and flexion-extension radiography.…”

Section: Discussionmentioning

confidence: 97%

Anterior cervical fusion with interbody cage containing β-tricalcium phosphate augmented with plate fixation: a prospective randomized study with 2-year follow-up

Dai

Jiang

2008

Eur Spine J

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A variety of bone graft substitutes, interbody cages, and anterior plates have been used in cervical interbody fusion, but no controlled study was conducted on the clinical performance of b-tricalcium phosphate (b-TCP) and the effect of supplemented anterior plate fixation. The objective of this prospective, randomized clinical study was to evaluate the effectiveness of implanting interbody fusion cage containing b-TCP for the treatment of cervical radiculopathy and/or myelopathy, and the fusion rates and outcomes in patients with or without randomly assigned plate fixation. Sixty-two patients with cervical radiculopathy and/or myelopathy due to soft disc herniation or spondylosis were treated with one-or twolevel discectomy and fusion with interbody cages containing b-TCP. They were randomly assigned to receive supplemented anterior plate (n = 33) or not (n = 29). The patients were followed up for 2 years postoperatively. The radiological and clinical outcomes were assessed during a 2-year follow-up. The results showed that the fusion rate (75.0%) 3 months after surgery in patients treated without anterior cervical plating was significantly lower than that (97.9%) with plate fixation (P \ 0.05), but successful bone fusion was achieved in all patients of both groups at 6-month follow-up assessment. Patients treated without anterior plate fixation had 11 of 52 (19.2%) cage subsidence at last follow-up. No difference (P [ 0.05) was found regarding improvement in spinal curvature as well as neck and arm pain, and recovery rate of JOA score at all time intervals between the two groups. Based on the findings of this study, interbody fusion cage containing b-TCP following one-or two-level discectomy proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Supplemented anterior plate fixation can promote interbody fusion and prevent cage subsidence but do not improve the 2-year outcome when compared with those treated without anterior plate fixation.

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“…Reformatted coronal and sagittal CT images make it possible to more clearly evaluate osseous continuity within the graft segment. Several CT studies have shown a higher degree of specificity for detecting pseudoarthrosis than plain radiography, particularly when evaluating interbody fusion [3,14,15]. The CT scan was assumed to be the ideal assessment method for suspected pseudoarthrosis.…”

Section: Discussionmentioning

confidence: 99%

Extension CT scan: its suitability for assessing fusion after posterior lumbar interbody fusion

et al. 2011

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Posterior lumbar interbody fusion (PLIF) is a popular procedure for treating lumbar canal stenosis with spinal instability, and several reports concerning fusion assessment methods exist. However, there are currently no definitive criteria for diagnosing a successful interbody fusion in the lumbar spine. We suggested evaluating fusion status using computed tomography (CT) in extension position to detect pseudoarthrosis more precisely. The purpose of this study was to evaluate its usefulness for determining bone union quality after PLIF. Eighty-one patients who underwent PLIF at 97 levels were retrospectively enrolled. The study population included 48 men and 33 women (mean age 58.9 years, range 21-85 years). Patients were followed up for more than 12 months after surgery. The mean follow-up period was 27.6 months (range 14-49 months). Fusion status was evaluated using three ways: flexionextension radiographs, CT images in flexion and extension position. In the flexion-extension radiographs, mobility of more than 3°, a remaining clear zone, or an uncertain bone connection constituted an incomplete union. For CT images, a remaining clear zone, a gas pattern, or an uncertain bone connection constituted an incomplete union. Flexionextension radiographs demonstrated a solid fusion in 90.7% of the 97 levels at 10.7 months postoperatively. When fusion was demonstrated on flexion-extension radiographs, the rate of fusion affirmed by flexion CT and extension CT was 87.6 and 69.1% of the levels assessed, respectively. The rate of pseudoarthrosis detected on extension CT images was significantly higher than that on flexion-extension radiographs (P \ 0.001) and flexion CT (P \ 0.01). The rate of fusion achieved on extension CT was 85.6% at 15.1 months postoperatively. Extension CT could detect pseudoarthrosis more clearly than flexion-extension radiography and flexion CT. The CT images are influenced by body position and dilating anterior disc space in extension CT contributes to detect pseudoarthrodesis. Thus, extension CT was a useful method for assessing fusion status after PLIF.

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Comparison of plain radiographs with CT scan to evaluate interbody fusion following the use of titanium interbody cages and transpedicular instrumentation

Cited by 116 publications

References 27 publications

CT-based classification of long spinal allograft fusion

CT-based classification of long spinal allograft fusion

Anterior cervical fusion with interbody cage containing β-tricalcium phosphate augmented with plate fixation: a prospective randomized study with 2-year follow-up

Extension CT scan: its suitability for assessing fusion after posterior lumbar interbody fusion

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