Interobserver and Intraobserver Reliability in the Radiologic Assessment of Lumbar Interbody Fusion

Kroeze, Robert Jan; Graat, Harm C.A.; Pluymakers, Winand J.; Marting, Louis N.; Dijk, Martijn van; Dijke, Cees F. van; Klis, Anton H. vd; Verberne, Steven J.; Gruyter, Albert J. de; Temmerman, Olivier P.P.

doi:10.1097/bsd.0000000000000423

Cited by 8 publications

(4 citation statements)

References 15 publications

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“…16 The substantial agreement between the 2 observers in this study was comparable with previous described results (j ¼ 0.52 ). 22 Overall complication rates in the current study were low (4%) and in concordance with the literature. 13,15,17,18 One of the frequent complications of lumbar interbody fusion and stand-alone ALIF in particular is pseudarthrosis.…”

Section: Secondary Outcome Measuressupporting

confidence: 91%

“…The assessment of fusion in the current study was done using plain radiographs. Recent literature has shown that interbody fusion can probably be better evaluated using CT scans; 22 however, for research purposes, it is difficult to obtain permission for CT scan of the patients due to the radiation dose. Therefore, x-rays are more appropriate.…”

Section: Limitationsmentioning

confidence: 99%

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Mid-Term and Long-Term Clinical and Radiological Outcomes of a Carbon I/F Stand-Alone Cage in Anterior Lumbar Interbody Fusion

et al. 2020

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Study Design: Retrospective cohort study. Objective: The current study was undertaken to determine the midterm and long-term radiological outcomes, complications and functional status of patients who underwent a single-level anterior interbody lumbar fusion (ALIF) procedure. Summary of Background Data: Low back pain affects 70%-90% of the general population at some point in their life, and in general, the majority are best treated by nonsurgical therapy. However, a lumbar fusion can be considered in selected cases. In previous decades, lumbar interbody fusion procedures have gained popularity. Despite the approach used, stand-alone interbody fusion is becoming less popular due to poor fusion rates. When studying ALIF procedures, the addition of instrumentation results in higher fusion rates. Nevertheless, long-term follow-up can give either unexpected or similar insights into certain procedures that should be available in the current literature. Therefore, the current study was undertaken to determine the midterm and long-term radiological outcomes, complications, and functional status of patients who underwent a single-level ALIF procedure. Methods: A cohort of 50 patients was studied following stand-alone ALIF for midterm and long-term follow-up of 6.6 years and 19.7 years, respectively. Primary outcome measurements were disability using the Oswestry Disability Index (ODI) score and pain scores using the visual analog scale, and the MOS 36-item Short-Form Health Survey (SF-36) was used to evaluate the quality of life. In addition, radiographic assessment was performed to indicate the number of solid fusions. Results: After a mean of 19.7 years, we had a loss to follow-up of 34%. Functional measurements revealed an ODI of 41 for both time points and an SF-36 physical component score around 41.4 and 40.8 for the midterm and longterm follow-up, respectively. The mental component of the SF-36 was 48.7 and 49.9, respectively. The assessment of interbody fusion revealed only 66% and 70% solid fusion after 6.6 years and 19.7 years, respectively. Conclusions: In concordance with previous studies, the outcome of midterm and long-term results in this study showed that the I/F cage in ALIF procedures is a safe treatment option for single-level interbody fusion. The radiological results corroborate literature regarding stand-alone interbody fusion, and additional instrumentation is likely to increase fusion rates. However, functional measurements reveal that the postsurgical situation remains likely worse than patients in a healthy Dutch population but possibly better that in a back pain population.

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Section: Secondary Outcome Measuressupporting

confidence: 91%

Section: Limitationsmentioning

confidence: 99%

Mid-Term and Long-Term Clinical and Radiological Outcomes of a Carbon I/F Stand-Alone Cage in Anterior Lumbar Interbody Fusion

et al. 2020

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“…Moreover, some studies determined fusion status based on plain radiographs or vague fusion criteria. 17,[19][20][21] Accordingly, it is possible that previously described criteria were subjective, and their fusion rates were overestimated. 22 The detailed description of our criterion will potentially eliminate the subjectivity and yield reliability.…”

Section: Discussionmentioning

confidence: 99%

The Significance of Extra-Cage Bridging Bone via Radiographic Lumbar Interbody Fusion Criterion

Lee

Jung

et al. 2021

Global Spine Journal

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Study Design: Prospective observational study. Objectives: We aimed to analysis the distributional patterns of the intra- and extra-cage bridging bone (InCBB and ExCBB) and the significance of ExCBB using suggested lumbar interbody fusion criterion. Methods: This study included the patients with planned single-level transforaminal lumbar interbody fusion. We divided bridging bone into InCBB (in void of right or left cage) and ExCBB (outside of cages; anterior, posterior, intermediate, right, or left) and graded bridging scores from 0 to 2 on postoperative 1-year computed tomography. The fusion was defined as at least having one or more graded 2 and the evaluation were conducted twice by 2 raters. Results: Sixty-five patients were enrolled. All values of intra- and inter-rater reliability in left InCBB, anterior, and posterior ExCBB showed good agreements (≥0.75). Both InCBBs showed similar mean bridging scores (Rt:1.43 vs Lt:1.48), and in ExCBBs, the anterior was the highest (1.43), followed by the posterior (1.14); the right and left were the lowest (0.49 and 0.52 respectively). In subjects determined as fusion (85.4%), complete bridging was observed more in ExCBB (88.8%) than in InCBB (69.9%). Conclusions: Given the higher bridging scores in both InCBBs and Ant. ExCBB, bone grafting is important promoting factor to increase the interbody bridging bone regardless of outside or in void of cages. Based on our suggested criterion, ExCBB has a greater proportion compared to InCBBs for determining the fusion and extra-cage bone grafting should be considered as important procedures for interbody fusion.

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“…Variability in bridging or residual motion following SIJFs might explain a proportion of the variability in clinical outcomes, but this cannot be investigated without the systematic use of a validated grading system. It is also important to use a multi-reviewer independent assessment as observer agreement in fusion assessment can be poor [ 11 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

The Assessment of Fusion Following Sacroiliac Joint Fusion Surgery

Abbasi

Hipp²

2017

Cureus

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Sacroiliac joint fusions (SIJF) have been the subject of many research studies. The technical success of an SIJF is in part determined by whether osseous bridging occurs across the sacroiliac joint (SIJ). However, no validated SIJF assessment method has been described. Our objective was to document previously described SIJF assessment methods and define and validate a detailed assessment system for SIJF. Our results are only intended to establish computed tomography (CT)-based guidelines for SIJF to be used in a subsequent large clinical study to correlate them with clinical outcomes.The SIJF literature was reviewed to document previous descriptions of SIJF assessments. A detailed system was then developed for assessing SIJF from CT exams. To provide data that can be used to address a range of research questions, the system included assessing bridging bone relative to the SIJ anatomy, bridging bone immediately adjacent to the threaded implants crossing the joint, as well as bridging bone close to but not immediately adjacent to the implants. The system was applied to assessing SIJF from thin-slice CT exams in 19 patients 12 months following surgery. Two experienced radiologists implemented the assessment system, and in the event of a disagreement, an adjudicator was used.Most prior studies provide very little detail about how SIJF was assessed. Using the new assessment system, the agreement between the primary readers was substantial (0.67 using Gwet’s AC1 statistic). Bridging bone representing a fusion of the SIJ was identified in most patients both immediately adjacent to the threaded implants crossing the joint, as well as distant to the implants.A detailed radiographic assessment system proved to be applicable to SIJF. The assessment system includes explicit language describing the location and extent of bridging bone across the SIJ. Standardization of the assessment of the SIJFs may allow for a more meaningful comparison of data between studies.

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Interobserver and Intraobserver Reliability in the Radiologic Assessment of Lumbar Interbody Fusion

Abstract: The Burkus classification system was classified as most reliable in this, but showed only moderate interobserver agreement. Therefore, the need for a more reliable classification system for the radiographic assessment of lumbar interbody fusion still exists to date.

Cited by 8 publications

References 15 publications

Mid-Term and Long-Term Clinical and Radiological Outcomes of a Carbon I/F Stand-Alone Cage in Anterior Lumbar Interbody Fusion

Mid-Term and Long-Term Clinical and Radiological Outcomes of a Carbon I/F Stand-Alone Cage in Anterior Lumbar Interbody Fusion

The Significance of Extra-Cage Bridging Bone via Radiographic Lumbar Interbody Fusion Criterion

The Assessment of Fusion Following Sacroiliac Joint Fusion Surgery

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