What is the most accurate radiographic criterion to determine anterior cervical fusion?

Riew, K. Daniel; Yang, Jae Jun; Chang, Dong‐Gune; Park, Sang Min; Yeom, Jin S.; Lee, Jae Sung; Jang, Eui Chan; Song, Kwang-Sup

doi:10.1016/j.spinee.2018.07.003

Cited by 42 publications

(49 citation statements)

References 18 publications

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“…Furthermore, our method of fusion assessment using radiographs may not be as accurate as computed tomography. 33 Nevertheless, our report should not be an overestimation of the fusion rates as we already used a strict definition of delayed union.…”

Section: Discussionmentioning

confidence: 80%

Anterior cervical discectomy and fusion for cervical myelopathy using stand-alone tricortical iliac crest autograft: Predictive factors for neurological and fusion outcomes

Yeung

Cheung

2019

J Orthop Surg (Hong Kong)

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Purpose: The purpose of this article is to investigate the outcomes after anterior cervical discectomy and fusion (ACDF) surgery with stand-alone tricortical iliac crest autograft and to determine predictive factors for poor neurological recovery, non-union, graft collapse and loss of C2–C7 sagittal alignment. Methods: This was a retrospective study involving patients with cervical myelopathy who underwent ACDF surgery with stand-alone tricortical iliac autograft between 2006 and 2016, with a minimum 2-year postoperative follow-up. Outcomes included the change in Japanese Orthopaedic Association (JOA) scores clinically and timing of fusion, graft height and C2–7 angle measured on lateral radiographs. Any complication such as neurological deterioration, non-union, graft collapse or loss of angle was recorded. Delayed union was considered as radiological union identified only beyond postoperative 6 months. Risk factors including age, smoking, drinking, comorbidities and operative levels were analysed through a multivariate regression for their respective influences on the various outcomes. Results: Of the 69 patients studied, none of the patients had non-union, while 33 (47.1%) achieved fusion in 6 months. The most common complications were anterior protrusion of graft (5.8%) and hoarseness (2.9%). The 1-year mean change in JOA score was 3.9 ± 2.7. The C2–7 angle gradually became more kyphotic, despite an initial lordosis correction intraoperatively. The graft height also gradually collapsed during subsequent follow-ups. Multivariate regression model suggested that diabetics (cumulative odds ratio 7.4) and drinkers (cumulative odds ratio 8.6) were associated with delayed union. Conclusion: ACDF using tricortical iliac crest autograft has satisfactory outcomes with low occurrence of complications. Diabetics and drinkers were predictors of delayed union.

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Section: Discussionmentioning

confidence: 80%

Anterior cervical discectomy and fusion for cervical myelopathy using stand-alone tricortical iliac crest autograft: Predictive factors for neurological and fusion outcomes

Yeung

Cheung

2019

J Orthop Surg (Hong Kong)

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“…Fusion status was also frequently assessed using dynamic lateral radiographs. Using this imaging technique, authors measured ISM (22 of 39, 56.4%) [ 10 , 13 , 14 , 16 , 19 - 22 , 25 , 28 , 29 , 31 , 33 - 39 , 41 - 43 ] or used the Cobb angle method (12 of 39, 30.8%) [ 11 , 15 , 17 , 27 , 32 , 34 , 37 , 42 - 46 ] to assess cervical fusion. No consensus was reached regarding the amount of motion for evaluation of cervical fusion on dynamic lateral radiographs.…”

Section: Resultsmentioning

confidence: 99%

“…No consensus was reached regarding the amount of motion for evaluation of cervical fusion on dynamic lateral radiographs. For the interspinous process method, no motion (9 of 22, 40.9%) [ 13 , 14 , 17 , 21 , 24 , 26 , 29 , 33 , 37 ], under 1 millimeter (mm) (7 of 22, 31.8%) [ 10 , 20 , 28 , 31 , 32 , 41 , 42 ], under 2 mm (2 of 22, 9.1%) [ 12 , 35 ], and under 3 mm of motion (4 of 22, 18.2%) [ 27 , 30 , 40 , 43 ] between spinous process were all used as cutoff values for a definition of fusion. Using the Cobb angle method, changes of 1 degree (1 of 12, 8.3%) [ 38 ], 1.5 degrees (1 of 12, 8.3%) [ 42 ], 2 degrees (5 of 12, 41.7%) [ 19 , 25 , 36 , 44 , 46 ], 4 degrees (4 of 12, 25.0%) [ 11 , 43 , 45 ], and 5 degrees (2 of 12, 16.7%) [ 27 , 30 ] were all used in various studies.…”

Section: Resultsmentioning

confidence: 99%

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Diagnosing Pseudoarthrosis After Anterior Cervical Discectomy and Fusion

Lin

Boddapati

et al. 2018

Neurospine

Self Cite

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Radiographic confirmation of fusion after anterior cervical discectomy and fusion (ACDF) surgery is a critical aspect of determining surgical success. However, there is a lack of established diagnostic radiographic parameters for pseudoarthrosis. The purpose of this study is to summarize the findings of previous studies, review the advantages and disadvantages of frequently employed diagnostic criteria, and present our recommended protocol of fusion assessment. This study identified randomized controlled trials, case-control studies, and prospective and retrospective cohort studies reporting on spinal fusion and how successful fusion after ACDF. Among the 39 articles reviewed, bridging bone across the operated levels on static radiographs was the most commonly used criteria to confirm fusion (31 of 39, 79%). Dynamic flexion-extension radiographs were used to assess for interspinous movement (ISM) (22 of 39, 56.4%) and change in Cobb angle (12 of 39, 30.8%). Computed tomography (CT) based findings (21 of 39, 53.8%) were employed in ambiguous cases with improved sensitivity and specificity. Reconstructed CT scans were used to assess for intragraft bridging bone and extragraft bridging bone (ExGBB). ExGBB were proved to have the highest diagnostic sensitivity and specificity for pseudoarthrosis detection when compared to all other radiographic criteria. The ISM <1 mm on dynamic flexion-extension radiographs had high diagnostic sensitivity and specificity as well. After our reviewing, we recommend using dynamic lateral flexion-extension cervical spine radiographs at 150% magnificationin which the interspinous motion <1 mm and superjacent interspinous motion ≥4 mm confirms fusion. In ambiguous cases, we recommend using reconstructed CT scans to evaluate for ExGBB.

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“…In cases where fusion was uncertain at 3 months, another CT scan was obtained at 6 months or at 12 months if fusion was still not solid. Solid intervertebral fusion was considered on the basis of the following criteria [16][17][18]: (1) a continuous bone bridge is seen between the intervertebral bodies in X-ray; (2) no movement of the fusion segment on the flexion-extension lateral Xray. (3) 3D-reconstruction CT scans showed the presence of bridging bone and/or the lack of radiolucency at the graft-vertebral junction in both the coronal and sagittal planes.…”

Section: Radiological Analysismentioning

confidence: 99%

Comparison of Recombinant Human Bone Morphogenetic Protein-2 versus Iliac Crest Autograft in Anterior Cervical Discectomy and Fusion

Shi¹,

Huang²,

Song³

et al. 2020

Preprint

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Backgroud The use of rhBMP-2 in anterior cervical discectomy and fusion (ACDF) is still “off-label” therapy because of higher incidence of potential complications such as adverse swelling, dysphagia, and airway compromise. The purpose of this study is to investigate whether the low dose rhBMP-2 (0.5 mg/level) decreases the incidence and severity of local complications in ACDF. Methods 173 consecutively patients from June 2015 to March 2016 at seven participating centers in the China were enrolled. All the patients had primary one- or two-level ACDF with either rhBMP-2(BMP, n=110) or iliac-crest bone autograft (IGB, n=63) were analyzed. Patients in both groups had compared preoperative pain and disability. The follow up timing was postoperative third days, postoperative-1, 3, 6 and 12 months. Results Patient demographics have no significantly difference between the BMP group and IGB group pre-operation (P>0.05). No significant difference in overall dysphagia incidence between the two groups (p > 0.05). There was significant difference of PSTS at C3 level between two groups at all interval time (P<0.01). There was significant difference of PSTS at C6 level at postoperative third days (P<0.01) and 3 months (0.010.05). No pseudarthrosis in both Groups. No significant difference in VAS scores, JOA and NDI .scores between two groups (P>0.05). Conclusion The adverse events associated with low dose rhBMP-2 for one- and two-level ACDF are rare. We recommend placing the rhBMP-2 carrier in the center of cage, and bilateral coverage of the carrier with excised local osteophytes.

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What is the most accurate radiographic criterion to determine anterior cervical fusion?

Cited by 42 publications

References 18 publications

Anterior cervical discectomy and fusion for cervical myelopathy using stand-alone tricortical iliac crest autograft: Predictive factors for neurological and fusion outcomes

Anterior cervical discectomy and fusion for cervical myelopathy using stand-alone tricortical iliac crest autograft: Predictive factors for neurological and fusion outcomes

Diagnosing Pseudoarthrosis After Anterior Cervical Discectomy and Fusion

Comparison of Recombinant Human Bone Morphogenetic Protein-2 versus Iliac Crest Autograft in Anterior Cervical Discectomy and Fusion

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