Reproducibility of tomographic evaluation of posterolateral lumbar arthrodesis consolidation

Abstract

<sec><title>OBJECTIVE:</title><p> To evaluate interobserver agreement of Glassman classification for posterolateral lumbar spine arthrodesis.</p></sec><sec><title>METHODS:</title><p> One hundred and thirty-four CT scans from patients who underwent posterolateral arthrodesis of the lumbar and lumbosacral spine were evaluated by four observers, namely two orthopedic surgeons experienced in spine surgery and two in training in this area. Using the reconstructed tomographic images at oblique coronal plane, 299 operated levels were systematically analyzed looking for arthrodesis signals. The appearance of bone healing in each operated level was classified in five categories as proposed by Glassman to the posterolateral arthrodesis: 1) bilateral solid arthrodesis; 2) unilateral solid arthrodesis; 3) bilateral partial arthrodesis; 4) unilateral partial arthrodesis; 5) absence of arthrodesis. In a second step, the evaluation of each operated level was divided into two categories: fusion (including type 1, 2, 3, and 4) and non fusion (type 5). Statistical analysis was performed by calculating the Kappa coefficient considering the paired analysis between the two experienced observers and between the two observers in training.</p></sec><sec><title>RESULTS:</title><p> The interobserver reproducibility by the kappa coefficient for arthrodesis consolidation analysis for the classification proposed, divided into 5 types, was 0.729 for both experienced surgeons and training surgeons. Considering only two categories kappa coefficient was 0.745 between experienced surgeons and 0.795 between training surgeons. In all analyzes, we obtained high concordance power.</p></sec><sec><title>CONCLUSION:</title><p> Interobserver reproducibility was observed with high concordance in the classification proposed by Glassman for posterolateral arthrodesis of the lumbar and lumbosacral spine.</p></sec>

Effect of Pulsed Electromagnetic Field on the Consolidation of Posterolateral Arthrodeses in the Lumbosacral Spine: A Prospective, Double-Blind, Randomized Study

“…The tomographic images, which included the entire arthrodesis area, were reconstructed with bone window imaging in the sagittal and oblique coronal planes 25 for each vertebral unit to be studied. Arya Pixeon© version 1.5.5 software was used for this analysis.…”

“…[25][26][27][28][29][30] The identification of continuity of trabecular bone between posterior elements of two adjacent vertebrae, either unilateral or bilateral, was considered consolidation.…”

“…18,35 In our study, we interpreted the presence or absence of fusion using the Glassman method, 24,30 to which we added the correction of the coronal plane at each level of arthrodesis to be studied. 25 The specific orientation of the coronal plane for each level of consolidation assessment makes the interpretation of the Glassman method clearer and more reproducible, especially at levels where there is a greater vertebral slope, as in the lumbosacral transition. The images were interpreted by two physicians who were experienced in the method, one of whom is a radiologist and the other an orthopedic spinal surgeon who was not involved in the surgical procedures.…”

“…25,26,28 Iliac autografts are considered the gold standard in studies evaluating spinal arthrodesis, as they present the best osteogenic, osteoinductive, and osteoconductive characteristics. 16,38,39 However, their use can contribute to morbidity in the donor area, prolonging surgical time, increasing blood loss and the risk of infection, and causing post-surgical pain.…”