Radiographic Changes in Patients with Pseudarthrosis After Posterior Lumbar Interbody Arthrodesis Using Carbon Interbody Cages

Kanemura, Tokumi; Matsumoto, Akiyuki; Ishikawa, Yoshimoto; Yamaguchi, Hidetoshi; Satake, Kotaro; Ito, Zenya; Yoshida, Go; Sakai, Yoshihito; Imagama, Shiro; Kawakami, Noriaki

doi:10.2106/jbjs.l.01527

Cited by 23 publications

(11 citation statements)

References 36 publications

(47 reference statements)

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“…Faster bone fusion occurred with the combined PRP graft, but plain radiographs did not show an overall increase in fusion; however, this may be because it is difficult to evaluate spinal fusion on plain radiographs only. 14 There may also have been bias in the comparison of prospective and historical cohort data, and therefore further investigation of the efficacy of PRP is needed.…”

Section: Discussionmentioning

confidence: 99%

“…The endpoints for evaluation were the area and mean density of bone fusion after PLF surgery on computed tomography (CT) at 2 weeks and 3, 6, and 12 months after surgery. For definition of successful fusion, we also evaluated the segmental range of motion under 5° on lateral flexion-extension radiographs with no radiolucent zones surrounding the pedicle screws on CT, 14 as well as continuous fusion mass formation between transverse processes on CT. For 10-year follow-up, all patients underwent plain radiography, CT, and magnetic resonance imaging at an outpatient clinic for evaluation of clinical symptoms and adverse events.…”

Section: Methodsmentioning

confidence: 99%

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Efficacy of Early Fusion With Local Bone Graft and Platelet-Rich Plasma in Lumbar Spinal Fusion Surgery Followed Over 10 Years

Imagama

Ando

Ishikawa

et al. 2017

Global Spine Journal

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Study Design:Prospective clinical study.Objective:Many oral surgeons use platelet-rich plasma (PRP) for bone defects, but the efficacy of PRP for spinal arthrodesis remains uncertain. The objective was to compare the efficacy of autologous local bone graft and PRP with local bone graft alone for promotion of bony union in posterolateral lumbar fusion (PLF) surgery, with investigation of the safety of PRP over 10 years.Methods:A prospective study was conducted in 29 consecutive patients who underwent one-level PLF at L4/5 for degenerative lumbar disease. Local bone on the left (control) side and local bone with PRP on the right side were grafted. The fusion area and absorption of grafted bone at 58 regions were determined using computed tomography at 2 weeks and 3, 6, and 12 months after surgery.Results:Average bone fusion areas on the PRP side were significantly wider at 3 and 6 months after surgery (P < .05). Average absorption values were significantly lower on the PRP side than on the control side at 3 and 6 months after surgery (P < .05). The PRP/control ratio was significantly different at 3 and 6 months compared to that at 2 weeks (P < .005). No adverse events related to PRP occurred with good clinical outcome over 10 years follow-up.Conclusions:Local application of PRP combined with autologous local bone graft has a positive impact on early fusion for lumbar arthrodesis with no adverse events over 10 years, and thus is a safe and low cost autologous option in spinal fusion.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Efficacy of Early Fusion With Local Bone Graft and Platelet-Rich Plasma in Lumbar Spinal Fusion Surgery Followed Over 10 Years

Imagama

Ando

Ishikawa

et al. 2017

Global Spine Journal

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“…Finally, the CT scans in the pseudarthrosis group were performed after a premature FU of only 9.9 months following the index surgery in comparison to 20.4 months in the cohort of patients without pseudarthrosis. Previous studies have, however, pointed out that significantly longer FU is required for an appropriate fusion assessment, and in these particular cases, the term 'delayed union' may be more appropriate than the term 'pseudarthrosis' [71][72][73].…”

Section: Interbody Fusion Assessmentmentioning

confidence: 99%

Anterior stand-alone fusion revisited: a prospective clinical, X-ray and CT investigation

et al. 2014

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The current study delineates satisfactory clinical results following ASAF at the lumbosacral junction. Patient safety was demonstrated with acceptable complication and low reoperation rates. Radiological data demonstrated a significant reconstruction of lordosis at the lumbosacral junction. Solid interbody fusion was achieved in 97.3 % of all cases in a highly selected cohort with optimal predisposition for fusion. ASAF may serve to avoid a variety of negative side effects for a considerable number of patients which, otherwise, would have been candidates for posterior instrumented fusion techniques.

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“…Based on the results of 5-year follow-up examinations, they reported that a radiolucent zone of more than 1 mm around the interbody cage at the 12-month mark was shown to be an early predictor of permanent pseudarthrosis in their cohort. 35 Similarly, Shah et al 56 reported that bridging trabeculation was appreciated on 95% of CT scans (k = 0.85) versus 4% on plain films (k = 0.74) for patients with lumbar interbody fusion. Based on these findings, the authors also suggest that thin-section CT scans should be the modality of choice for the early detection of pseudarthrosis.…”

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confidence: 98%

“…7,22 While there are no universally accepted criteria for assessing interbody bone fusion, most studies use all or some of the following features for defining pseudarthrosis: complete absence of continuous bony trabeculation between adjacent vertebrae, peri-implant radiolucency, and/or motion on dynamic films. 35,56,57 Early studies using CT scans have shown 57% to 80% correlation between fusion assessments based on imaging versus intraoperative findings, with 53% to 63% sensitivity and 78% to 86% specificity. 7,42,54 Since then, there have been considerable advancements in CT technology with the introduction of thin-section axial sequencing and 3D imaging (Fig.…”

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confidence: 99%

Lumbar pseudarthrosis: a review of current diagnosis and treatment

Chun

Baker

Hsu

2015

FOC

141

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OBJECT Failed solid bony fusion, or pseudarthrosis, is a well-known complication of lumbar arthrodesis. Recent advances in radiographic technology, biologics, instrumentation, surgical technique, and understanding of the local biology have all aided in the prevention and treatment of pseudarthrosis. Here, the current literature on the diagnosis and management of lumbar pseudarthroses is reviewed. METHODS A systematic literature review was conducted using the MEDLINE and Embase databases in order to search for the current radiographie diagnosis and surgical treatment methods published in the literature (1985 to present). Inclusion criteria included: 1) published in English; 2) level of evidence I–III; 3) diagnosis of degenerative lumbar spine conditions and/or history of lumbar spine fusion surgery; and 4) comparative studies of 2 different surgical techniques or comparative studies of imaging modality versus surgical exploration. RESULTS Seven studies met the inclusion criteria for current radiographie imaging used to diagnose lumbar pseudarthrosis. Plain radiographs and thin-cut CT scans were the most common method for radiographie diagnosis. PET has been shown to be a valid imaging modality for monitoring in vivo active bone formation. Eight studies compared the surgical techniques for managing and preventing failed lumbar fusion. The success rates for the treatment of pseudarthrosis are enhanced with the use of rigid instrumentation. CONCLUSIONS Spinal fusion rates have improved secondary to advances in biologies, instrumentation, surgical techniques, and understanding of local biology. Treatment of lumbar pseudarthrosis includes a variety of surgical options such as replacing loose instrumentation, use of more potent biologies, and interbody fusion techniques. Prevention and recognition are important tenets in the algorithm for the management of spinal pseudarthrosis.

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Radiographic Changes in Patients with Pseudarthrosis After Posterior Lumbar Interbody Arthrodesis Using Carbon Interbody Cages

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 23 publications

References 36 publications

Efficacy of Early Fusion With Local Bone Graft and Platelet-Rich Plasma in Lumbar Spinal Fusion Surgery Followed Over 10 Years

Efficacy of Early Fusion With Local Bone Graft and Platelet-Rich Plasma in Lumbar Spinal Fusion Surgery Followed Over 10 Years

Anterior stand-alone fusion revisited: a prospective clinical, X-ray and CT investigation

Lumbar pseudarthrosis: a review of current diagnosis and treatment

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