Pseudarthrosis following lumbar fusion: detection by direct coronal CT scanning.

Chafetz, Neil; Cann, C E; Morris, J. Carrell; Steinbach, L S; Goldberg, Henry I.; Ax, Liv

doi:10.1148/radiology.162.3.3809497

Cited by 41 publications

(17 citation statements)

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“…Until now, most studies focus on morphological imaging techniques to evaluate the healing process of intercorporal fusions. Obviously, there seems to be no uniform radiological criteria for assessing intercorporal fusion by plain radiographs or CT [10,[15][16][17][18]. 18F-fluoride PET/(CT) on the contrary has mostly been used in the assessment of malignant bone abnormalities [19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Assessment of successful incorporation of cages after cervical or lumbar intercorporal fusion with [(18)F]fluoride positron-emission tomography/computed tomography

Fischer

Zweifel²,

Treyer

et al. 2010

Eur Spine J

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The purpose of this study is to assess the successful incorporation of cages in patients after cervical or lumbar intercorporal fusion with positron-emission tomography/computed tomography (PET/CT). Twenty patients (14 female and 6 male; mean age 58 years, age range 38-73 years) with 30 cervical (n = 13) or lumbar (n = 17) intercorporal fusions were prospectively enrolled in this study. Time interval between last intercorporal intervention and PET/CT ranged from 2 to 116 months (mean 63; median 77 months). IRB approval was obtained for all patients, and written informed consent was obtained from all patients. About 30 min prior to PET/CT scanning, 97-217 MBq (mean 161 MBq) 18F-fluoride were administered intravenously. Patients were imaged in supine position on a combined PET/CT system (Discovery RX/STE, 16/64 slice CT, GE Healthcare). 3D-PET emission data were acquired for 1.5 and 2 min/bed position, respectively, and reconstructed by a fully 3D iterative algorithm (VUE Point HD) using low-dose CT data for attenuation correction. A dedicated diagnostic thin-slice CT was optionally acquired covering the fused region. Areas of increased 18F-fluoride uptake around cages were determined by one double-board certified radiologist/ nuclear physician and one board certified radiologist in consensus. In 12/20 (60%) patients, increased 18F-fluoride uptake around cages was observed. Of the 30 intercorporal fusions, 15 (50%) showed increased 18F-fluoride uptake. Median time between intervention and PET/CT examination in cages with increased uptake was 37 months (2-116 months), median time between intervention and PET/CT examination in those cages without increased uptake was 91 months (19-112 months), p (Wilcoxon) = 0.01 (one-sided). 14/29 (48%) cages with a time interval [ 1 year between intervention and PET/CT scan showed an increased uptake. In conclusion, PET/CT frequently shows increased 18F-fluoride uptake in cervical and lumbar cages older than 1 year (up to almost 8 years in cervical cages and 10 years in lumbar cages) possibly indicating unsuccessful fusion due to increased stress/ microinstability.

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Section: Discussionmentioning

confidence: 99%

Assessment of successful incorporation of cages after cervical or lumbar intercorporal fusion with [(18)F]fluoride positron-emission tomography/computed tomography

Fischer

Zweifel²,

Treyer

et al. 2010

Eur Spine J

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show abstract

“…18 Similarly, Chafetz et al demonstrated that direct coronal CT scanning may be more sensitive than 2D reconstructed coronal CT images for the detection of pseudarthrosis. 8 Zinreich and colleagues reported that 3D CT reconstruction may be more sensitive than 2D CT reconstruction for the detection of pseudarthrosis. 26 Siambanes and Mather demonstrated that multiplanar CT imaging detected pseudarthrosis in patients who had undergone PLIF, compared with plain radiography, which had suggested a solid fusion.…”

Section: Computed Tomographymentioning

confidence: 99%

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: Radiographic assessment of fusion status

Choudhri

Mummaneni

Dhall

et al. 2014

SPI

102

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The ability to identify a successful arthrodesis is an essential element in the management of patients undergoing lumbar fusion procedures. The hypothetical gold standard of intraoperative exploration to identify, under direct observation, a solid arthrodesis is an impractical alternative. Therefore, radiographic assessment remains the most viable instrument to evaluate for a successful arthrodesis. Static radiographs, particularly in the presence of instrumentation, are not recommended. In the absence of spinal instrumentation, lack of motion on flexion-extension radiographs is highly suggestive of a successful fusion; however, motion observed at the treated levels does not necessarily predict pseudarthrosis. The degree of motion on dynamic views that would distinguish between a successful arthrodesis and pseudarthrosis has not been clearly defined. Computed tomography with fine-cut axial images and multiplanar views is recommended and appears to be the most sensitive for assessing fusion following instrumented posterolateral and anterior lumbar interbody fusions. For suspected symptomatic pseudarthrosis, a combination of techniques including static and dynamic radiographs as well as CT images is recommended as an option. Lack of facet fusion is considered to be more suggestive of a pseudarthrosis compared with absence of bridging posterolateral bone. Studies exploring additional noninvasive modalities of fusion assessment have demonstrated either poor potential, such as with 99mTc bone scans, or provide insufficient information to formulate a definitive recommendation.

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“…More recently, thin-section helical CT scanning has become the most reliable method for assessing fusion [4,13]. Reformatted coronal and sagittal CT images make it possible to more clearly evaluate osseous continuity within the graft segment.…”

Section: Discussionmentioning

confidence: 99%

“…CT has developed into the preferred method for assessing interbody fusion [4,13]. It is rapid and provides reformatted images in the coronal and sagittal planes.…”

Section: Introductionmentioning

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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Pseudarthrosis following lumbar fusion: detection by direct coronal CT scanning.

Cited by 41 publications

References 0 publications

Assessment of successful incorporation of cages after cervical or lumbar intercorporal fusion with [(18)F]fluoride positron-emission tomography/computed tomography

Assessment of successful incorporation of cages after cervical or lumbar intercorporal fusion with [(18)F]fluoride positron-emission tomography/computed tomography

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: Radiographic assessment of fusion status

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

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