Symposium: A Critical Discrepancy—A Criteria of Successful Arthrodesis Following Interbody Spinal Fusions

McAfee, Paul C.; Boden, Scott D.; Brantigan, John W.; Fraser, Robert D.; Kuslich, Stephen D.; Oxland, Thomas R.; Panjabi, Manohar M.; Ray, Charles D.; Zdeblick, Thomas A.

doi:10.1097/00007632-200102010-00020

Cited by 185 publications

(131 citation statements)

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“…Several radiographic approaches have been attempted to detect pseudoarthrosis, including plain radiographs, flexion-extension radiographs, and CT scans with reconstructions. However, the definition of successful arthrodesis following lumbar fusion is controversial [12].…”

Section: Discussionmentioning

confidence: 99%

“…The likely reasons for this are numerous. Metal implants often obscure the trabecular remodeling and fusion image: due to the inherently strong stability provided by most posterior internal fixation systems and interbody cages, flexion-extension radiographs cannot detect the subtle motion often seen in nonunions; movement can also be masked by muscle guarding and compensation with hip flexion [12]. Moreover, measurement accuracy is largely dependent on obtaining true lateral views; hence, suboptimal radiographs are often obtained [6].…”

Section: Discussionmentioning

confidence: 99%

“…The imaging techniques currently employed to assess the status of a spinal fusion include plain radiographs, flexion-extension radiographs, and computed tomography (CT) scans, including twodimensional or three-dimensional reconstructions. However, currently there is no universally accepted radiologic assessment method for determining fusion, and the definitive criteria for diagnosing a successful interbody fusion in the lumbar spine remain controversial [12].…”

Section: Introductionmentioning

confidence: 99%

“…However, there is a lack of consensus concerning the degree of detected movement that demonstrates nonunion [12]. Technical measurement errors are inevitable when assessing dynamic radiographs [6], and metal artifacts obscure the image.…”

Section: Introductionmentioning

confidence: 99%

“…However, CT images do not determine the extent of bone fusion present as accurately as a histological evaluation [7,10]. One reason for this problem is that plain CT scans are subject to artifact interference through and adjacent to the fusion device [12]. Another is that CT images may change depending on the positioning of the subject.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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Comparison of polyetheretherketone versus silicon nitride intervertebral spinal spacers in a caprine model

Kersten

Pouran

et al. 2018

J Biomed Mater Res

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Polyetheretherketone (PEEK) is commonly used as a spinal spacer for intervertebral fusion surgery. Unfortunately, PEEK is bioinert and does not effectively osseointegrate into living bone. In contrast, comparable spacers made of silicon nitride (Si N ) possess a surface nanostructure and chemistry that encourage appositional bone healing. This observational study was designed to compare the outcomes of these two biomaterials when implanted as spacers in an adult caprine model. Lumbar interbody fusion surgeries were performed at two adjacent levels in eight adult goats using implants of PEEK and Si N . At six-months after surgery, the operative and adjacent spinal segments were extracted and measured for bone fusion, bone volume, bone-implant contact (BIC) and soft-tissue implant contact (SIC) ratios, and biodynamic stability. The null hypothesis was that no differences in these parameters would be apparent between the two groups. Fusion was observed in seven of eight implants in each group with greater bone formation in the Si N group (52.6%) versus PEEK (27.9%; p = 0.2). There were no significant differences in BIC ratios between PEEK and Si N , and the biodynamic stability of the two groups was also comparable. The results suggest that Si N spacers are not inferior to PEEK and they may be more effective in promoting arthrodesis. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 00B: 000-000, 2018.

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Evaluation of lumbar spinal fusion utilizing recombinant human platelet derived growth factor‐B chain homodimer (rhPDGF‐BB) combined with a bovine collagen/β‐tricalcium phosphate (β‐TCP) matrix in an ovine model

et al. 2021

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Background context While the clinical effectiveness of recombinant human Platelet Derived Growth Factor‐B chain homodimer combined with collagen and β‐tricalcium phosphate (rhPDGF‐BB + collagen/β‐TCP) treatment for indications involving hindfoot and ankle is well‐established, it is not approved for use in spinal interbody fusion, and the use of autograft remains the gold standard. Purpose The purpose of this study was to compare the effects of rhPDGF‐BB + collagen/β‐TCP treatment on lumbar spine interbody fusion in an ovine model to those of autograft bone and collagen/β‐TCP treatments using biomechanical, radiographic, and histological assessment techniques. Study design Thirty‐two skeletally mature Columbian Rambouillet sheep were used to evaluate the safety and effectiveness of rhPDGF‐BB + collagen/β‐TCP matrix in a lumbar spinal fusion model. Interbody polyetheretherketone (PEEK) cages contained either autograft, rhPDGF‐BB + collagen/β‐TCP, collagen/β‐TCP matrix, or left empty. Methods Animals were sacrificed 8‐ or 16‐weeks post‐surgery. Spinal fusion was evaluated via post‐sacrifice biomechanical, micro‐computed tomography (μCT), and histological analysis. Outcomes were statistically compared using a two‐way analysis of variance (ANOVA) with an alpha value of 0.05 and a Tukey post‐hoc test. Results There were no statistically significant differences between groups within treatment timepoints for flexion‐extension, lateral bending, or axial rotation range of motion, neutral zone, neutral zone stiffness, or elastic zone stiffness. μCT bone volume fraction was significantly greater between treatment groups independent of timepoint where Autograft and rhPDGF‐BB + collagen/β‐TCP treatments demonstrated significantly greater bone volume fraction as compared to collagen/β‐TCP (P = .026 and P = .038, respectively) and Empty cage treatments (P = .002 and P = .003, respectively). μCT mean bone density fraction was most improved in rhPDGF‐BB + collagen/β‐TCP specimens at the 8 week and 16‐week timepoints as compared to all other treatment groups. There were no statistically significant differences in histomorphometric measurements of bone, soft tissue, or empty space between rhPDGF‐BB + collagen/β‐TCP and autograft treatments. Conclusions The results of this study indicate that the use of rhPDGF‐BB combined with collagen/β‐TCP promotes spinal fusion comparable to that of autograft bone. Clinical significance The data indicate that rhPDGF‐BB combined with collagen/β‐TCP promotes spinal fusion comparably to autograft bone treatment and may offer a viable alternative in large animal spinal fusion. Future prospective clinical studies are necessary to fully understand the role of rhPDGF‐BB combined with collagen/β‐TCP in human spinal fusion healing.

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Symposium: A Critical Discrepancy—A Criteria of Successful Arthrodesis Following Interbody Spinal Fusions

Cited by 185 publications

References 0 publications

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

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

Comparison of polyetheretherketone versus silicon nitride intervertebral spinal spacers in a caprine model

Evaluation of lumbar spinal fusion utilizing recombinant human platelet derived growth factor‐B chain homodimer (rhPDGF‐BB) combined with a bovine collagen/β‐tricalcium phosphate (β‐TCP) matrix in an ovine model

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