Correlation of Radiologic Assessment of Lumbar Spine Fusions with Surgical Exploration

Brodsky, Alex; Kovalsky, Evan S.; Khalil, Momtaz A.

doi:10.1097/00007632-199106001-00017

Cited by 242 publications

(135 citation statements)

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“…There are, however, several studies concluding that that plain radiological assessment, including flexion/extension films, computed tomography and tomograms, is insufficient for determining whether a fusion mass is solid or pseudoarthrotic [3,4,12]. Also, a recent study by PihlajamSki et al [21] showed no correlation between radiolgocially evaluated fusion and clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome after spinal fusion with a rigid versus a semi-rigid pedicle screw system

et al. 1997

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Several biomechanical studies have evaluated the quality of fusion obtained with a rigid versus a semi-rigid pedicle screw implant. Some studies indicate that increased rigidity of the implant system results in an increased strength of the fusion mass. Other reports have underlined the risk of stress shielding due to rigid implant systems. Based on these findings some authors have recommended the use of a semi-rigid system. There are, however, few studies focusing on any possible difference in clinical outcome between the two different types of implant systems. Questionnaires were sent to 89 patients who had undergone primary spinal fusion with either a rigid or a semi-rigid pedicle-screw-based implant system. In every case the diagnosis was spondylolisthesis or degenerative lumbar disease. The questionnnaires were analysed using forward stepwise logistic regression analysis. Eighty (90%) of the questionnaires were returned. There was a mean follow-up of 4 years (range 2-8 years). It was not possible to demonstrate any difference in clinical outcome between patients undergoing lumbar fusion with a rigid implant system and those given a semirigid system. The overall patient satisfaction rate was 69%, with no difference between the two types of implant. No difference in clinical outcome between the two types of implant was found. Considering the fact that the primary goal of spinal fusion procedure is to obtain a solid fusion mass, biomechanical tests favour the used of a rigid pedicle screw system. This fact combined with the fact that early mobilisation is possible with rigid implants justifies the use of rigid implant systems, although no difference in clinical outcome could be demonstrated in this study.

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Section: Discussionmentioning

confidence: 99%

Clinical outcome after spinal fusion with a rigid versus a semi-rigid pedicle screw system

et al. 1997

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“…However, these studies included multiple diagnostic groups, and clinical as well as radiological outcomes were not always reported. Standard radiographs were used to assess fusion, which has been shown to underestimate pseudarthrosis rates [3,5,7].…”

Section: Introductionmentioning

confidence: 99%

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Faúndez¹,

Schwender

Safriel³

et al. 2009

Eur Spine J

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Abundant data are available for direct anterior/ posterior spine fusion (APF) and some for transforaminal lumbar interbody fusion (TLIF), but only few studies from one institution compares the two techniques. One-hundred and thirty-three patients were retrospectively analyzed, 68 having APF and 65 having TLIF. All patients had symptomatic disc degeneration of the lumbar spine. Only those with one or two-level surgeries were included. Clinical chart and radiologic reviews were done, fusion solidity assessed, and functional outcomes determined by pre-and postoperative SF-36 and postoperative Oswestry Disability Index (ODI), and a satisfaction questionnaire. The minimum follow-up was 24 months. The mean operating room time and hospital length of stay were less in the TLIF group. The blood loss was slightly less in the TLIF group (409 vs. 480 cc.). Intra-operative complications were higher in the APF group, mostly due to vein lacerations in the anterior retroperitoneal approach. Postoperative complications were higher in the TLIF group due to graft material extruding against the nerve root or wound drainage. The pseudarthrosis rate was statistically equal (APF 17.6% and TLIF 23.1%) and was higher than most published reports. Significant improvements were noted in both groups for the SF-36 questionnaires. The mean ODI scores at follow-up were 33.5 for the APF and 39.5 for the TLIF group. The patient satisfaction rate was equal for the two groups.

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“…However, a helical CT scan is more likely to overestimate the extent of bone fusion than histological studies. Previous studies on the accuracy of CT sagittal reconstructions reported only a 60-80% correlation with surgical exploration [2,5,10]. This sizeable discrepancy (20-40%) is no doubt due to some factors that adversely affect the images obtained via CT.…”

Section: Discussionmentioning

confidence: 97%

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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Correlation of Radiologic Assessment of Lumbar Spine Fusions with Surgical Exploration

Cited by 242 publications

References 0 publications

Clinical outcome after spinal fusion with a rigid versus a semi-rigid pedicle screw system

Clinical outcome after spinal fusion with a rigid versus a semi-rigid pedicle screw system

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

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

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