CT-based classification of long spinal allograft fusion

Tan, Gerald; Goss, Ben; Thorpe, Paul; Williams, Richard

doi:10.1007/s00586-007-0376-0

Cited by 78 publications

(54 citation statements)

References 26 publications

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“…Unlike other specialties, in which radiographic standards have been developed to assess bone healing, no standards exist to assess bony healing after a sternotomy [16][17][18][19]. The methods developed for other orthopaedic specialties have clinical implications, and may be used to determine when patients may return to normal activities or when hardware may be removed.…”

Section: Commentmentioning

confidence: 99%

Evaluation of Sternal Bone Healing with Computed Tomography and a Quantitative Scoring Algorithm

Stacy¹,

Ahmed²,

Richardson³

et al. 2014

TOMIJ

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Abstract:Objective: The exquisite bone detail offered by computed tomography makes it the ideal modality for evaluation of bone healing. However, few studies have investigated the normal computed tomographic appearance of the sternum after median sternotomy and, to the best of our knowledge, no computed tomographic classification of sternal healing has been proposed. Given the potential benefit of objective criteria, we propose a validated scoring classification of sternal healing using computed tomography for both clinical and investigational purposes.Methods: Computed tomography scans from 20 patients who underwent a median sternotomy were evaluated for sternal healing at either 3 or 6 months postoperatively. Five anatomic locations along the sternum were selected using defined criteria, and a 6-point quantitative scale was developed to evaluate sternal healing. Independent radiologists read and scored each of the 5 locations on the sternum. Inter-and intra-observer variability was assessed by calculating the kappa statistics to measure the reliability of the scoring algorithm.Results: Calculation of the kappa statistics indicated substantial agreement for intra-observer variability and substantial to almost perfect agreement for inter-observer variability. For intra-observer variability, the kappa statistics ranged from 0.591 to 0.802, and for inter-observer variability, the kappa statistics ranged from 0.590 to 0.969. When the two radiologists differed, the magnitude of the difference was no more than 1 or 2 points. Conclusion:This simple system of evaluating sternal healing had high inter-and intra-observer reliability. Therefore, it may be considered a valid method for assessing sternal osteosynthesis for both clinical and investigative purposes.Ultramini abstract: (49 words): Few studies have investigated the normal computed tomography appearance of the sternum after median sternotomy, and we knew of no computed tomography-based classification of sternal healing. Given the potential benefit of objective criteria, we designed and validated a scoring classification of sternal osteosynthesis for both clinical and investigational purposes.

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Section: Commentmentioning

confidence: 99%

Evaluation of Sternal Bone Healing with Computed Tomography and a Quantitative Scoring Algorithm

Stacy¹,

Ahmed²,

Richardson³

et al. 2014

TOMIJ

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“…The total pooled pseudoarthrosis rate was 4.3% in a meta-analysis for LLIF in adult degenerative scoliosis series 2) . Basically CT is thought to be more reliable than functional X-rays to detect nonunion or pseudoarthrosis of interbody fusion [17][18][19][20][21] .…”

Section: Discussion Discussion Discussionmentioning

confidence: 99%

Nonunion of Transpsoas Lateral Lumbar Interbody Fusion Using an Allograft: Clinical Assessment and Risk Factors

Satake

Kanemura

Nakashima

et al. 2018

Spine Surg Relat Res

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Methods Methods Methods MethodsSixty-three patients who underwent transpsoas LLIF (69.8 ± 8.9 years, 21 males and 42 females, 125 segments) were followed for a minimum 2 years postoperatively. For all LLIF segments, polyetheretherketone (PEEK) cages packed with allogenic bone were applied with supplemental bilateral pedicle screws (PSs). Bone bridge formation was evaluated by computed tomography (CT) 2 years postoperative, and a segment without any bridge formation was determined to be a nonunion. Sixty-one participants (96.8%) were classified into two groups for clinical evacuation: Group N that contained one or more nonunion segments and Group F that contained no nonunion segment. Visual analogue scales (VAS)scores and the effective rates of the five domains of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were compared between Groups N and F.The risk factors for nonunion were determined by univariate and multivariate analyses. Results Results Results Results 3Twenty segments (16%) were diagnosed as nonunion. There were no significant differences in all VAS scores, and the ratio of effective cases in all domains of JOABPEQ between Group N (n = 14) and F (n = 47). Multivariate analysis identified percutaneous PS (PPS) usage (odds ratio [OR]: 3.14, 95% confidence interval: 1.13-8.68, p = 0.028) as a positive risk factor for nonunion. Conclusions Conclusions Conclusions ConclusionsWe should be aware of the higher nonunion rate in the LLIF segments supplemented with PPS, though nonunion does not affect significantly clinical outcomes at 2 years postoperative.

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“…Though technically demanding, PLIF procedure showed good fusion rates about 85 %. It had few disadvantages like Graft extrusion, dural injury, Nerve injury, arachnoiditis and excess blood loss [8,9,10] . Once the cylinders are screwed into position, they give remarkably good fixation.…”

Section: Discussionmentioning

confidence: 99%

Cage vs autologous bone grafting in PLIF surgery for spine fusion- randomized control trial

Patil¹,

Bhor²,

Ranjan³

et al. 2017

Int. J. Orthop. Sci.

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Introduction: Posterior lumbar interbody fusion (PLIF) is been used increasingly for degenerative lumbar spine disease to achieve a 360 degree fusion. With the advent of newer techniques and instrumentations the results are good. Aim: To study the outcome of PLIF with cages and that with bone graft for degenerative Lumbar spinal canal stenosis. Material and Methods:We did a double blinded randomized controlled trial at single center. All patients who met with our inclusion criteria and operated from 2007 to 2010 were included in our study. The patients were followed up serially for 5 years for the final outcome. Modified Oswestry low back score and final CT scan based interpretations were applied. Results: Totally 101 patients were included in the study of which 53 underwent PLIF with titanium cage and rest 48 underwent PLIF with bone grafting. We found the results of union rates in both the groups were gratifying, but early and better results with fewer complications were in group with titanium cages. Conclusion: We fairly conclude that better and faster fusion rates with good ambulation can be achieved with titanium cages rather than bone grafting in degenerative lumbar spine disease.

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CT-based classification of long spinal allograft fusion

Cited by 78 publications

References 26 publications

Evaluation of Sternal Bone Healing with Computed Tomography and a Quantitative Scoring Algorithm

Evaluation of Sternal Bone Healing with Computed Tomography and a Quantitative Scoring Algorithm

Nonunion of Transpsoas Lateral Lumbar Interbody Fusion Using an Allograft: Clinical Assessment and Risk Factors

Cage vs autologous bone grafting in PLIF surgery for spine fusion- randomized control trial

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