Radiological Fusion Criteria of Postoperative Anterior Cervical Discectomy and Fusion: A Systematic Review

Oshina, Masahito; Oshima, Yasushi; Tanaka, Sakae; Riew, K. Daniel

doi:10.1177/2192568218755141

Cited by 66 publications

(65 citation statements)

References 74 publications

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“…Furthermore, FRs were reported as 90.2% at 1 year and 94.7% at 2 years. [ 7 ] Based on the aforementioned results, the second criteria system was employed in the evaluation process. The 1 st year FR was 100%, with a significant peak registered between months 3 and 6, as shown in Figure 2 .…”

Section: Discussionmentioning

confidence: 99%

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Long-term outcome following three-level stand-alone anterior cervical discectomy and fusion: Is plating necessary?

Theologou

Skoulios

et al. 2020

Asian J Neurosurg

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Background: Anterior cervical discectomy with fusion (ACDF) is a proven method for the treatment of selected patients. The necessity of use of an anterior plate is controversial. The article aims to assess the fusion rates (FRs) and long-term outcomes following three-level ACDF. Materials and Methods: Data were collected from the medical records of patients operated on due to degenerative cervical disease. All patients were treated with three-level ACDF employing polyether ether-ketone cages without anterior plating. Visual analog scale (VAS), neck disability index (NDI), and plain radiographs were used in the clinical and radiological postsurgery assessment. Fusion evaluation was performed according to the <1 mm motion between spinous processes rule. Subsidence was defined as a more than 2 mm decrease in the interbody height. Results: A total of 234 treated levels on 78 patients were assessed. The mean presurgery NDI score was 23.07 ± 4.86, with a mean disability of 46.03% ± 9.64. The mean presurgery VAS score of the neck was 7.58 ± 0.85, while VAS score of the arm was 7.75 ± 1.008. Post surgery, NDI stated no disability, while VAS score of the neck and arm showed no presence of pain. The mean FR was 19.50 ± 21.71 levels per month, with a peak from 3 rd to 6 th month. Presurgery evaluation showed 12 (15.38%) patients with a high T2 sequence signal. Magnetic resonance imaging screening detected 31 (39.24%) patients with coexisting cervical and lumbar findings. Post surgery, transient dysphagia was reported by 1 patient (1.28%), while subsidence was registered in 15 (6.41%) levels, situated in 12 patients (15.38%), most often at C 6-7 (66.6%). Clinical and radiological follow-up extended to 69.47 ± 11.45 months. Conclusion: Multilevel stand-alone ACDF is a safe, cost-effective procedure providing favorable clinical and radiological results with minimal complications. The incidence of subsidence is usually clinically insignificant and can be decreased with a careful surgical technique.

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Section: Discussionmentioning

confidence: 99%

“…FR was evaluated employing the <1 mm motion between the spinous processes system. [ 7 ] Subsidence was defined as a more than 2 mm decrease of the interbody height. [ 8 ] Plain radiograph measurements were compered to MRI to define magnification by an experienced independent radiologist.…”

Section: Methodsmentioning

confidence: 99%

Long-term outcome following three-level stand-alone anterior cervical discectomy and fusion: Is plating necessary?

Theologou

Skoulios

et al. 2020

Asian J Neurosurg

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“…Currently, there are no universally agreed upon diagnostic radiographic or clinical criteria for PA. Several sets of criteria have been used to assess fusion status based on radiographic evidence. 6 – 8 , 18 The plain radiographic ISM criteria for fusion at the arthrodesis level was defined in this study as ISM <1 mm, and at a non-arthrodesed superjacent level was defined as ISM ≥4 mm. This set of criteria is endorsed by the Cervical Spine Research Society and is well-accepted in the literature.…”

Section: Discussionmentioning

confidence: 99%

“… 4 , 5 There is a relative lack of consensus in the literature regarding criteria for the diagnosis of PA, and there is currently no consensus on the management of asymptomatic patients who have delays in radiographic union. 6 – 8 A routine treatment currently utilized for the management of symptomatic PA is repeat surgical intervention with the goal of obtaining arthrodesis. A study by van Eck et al reported that among 672 patients undergoing ACDF, the reoperation rate was 15% within an average of 31 months of follow-up, and PA was the reason for reoperation in nearly half of patients.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Radiographic and Functional Outcomes of Patients With Absence of Radiographic Union at 2 Years After Single-Level Anterior Cervical Discectomy and Fusion

Lee

Boody

Demeter

et al. 2019

Global Spine Journal

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Study Design: Retrospective radiographic investigation. Objective: To evaluate the long-term radiographic and functional outcomes of patients in whom there is absence of radiographic union at 2 years after single-level anterior cervical discectomy and fusion (ACDF). Methods: Thirty-one patients were evaluated at standard postoperative time intervals per index trial protocol. Plain film radiographic fusion criteria at the arthrodesis level was defined as interspinous motion (ISM) <1 mm with corresponding motion at a non-arthrodesed superjacent level ISM ≥4 mm. Radiographs and functional outcome measures were acquired at each follow-up visit. Delayed union was defined as lack of radiographic union by 24 months. Results: Nine patients demonstrated radiographic evidence of delayed radiographic union at 24 months. Of those 9 patients, 5 patients demonstrated evidence of union during the follow-up period to 72 months. Despite the absence of radiographic union based on our criteria, 3 of the 4 remaining patients reported remarkable improvements in pain scores and functional outcomes. Conclusions: The natural history of delayed union at 24 months after ACDF was still favorable despite the prolonged delay in union. The majority of patients (5 of 9) without radiographic union at 24 months did proceed to radiographic union by final follow-up. In addition, patients that did not meet our criteria for fusion maintained postoperative improvements in patient-reported outcome scores. In summary, our study patients undergoing a single-level ACDF with asymptomatic radiographic delayed union at 24 months can expect maintained improvements in postoperative patient-reported outcomes scores and can still progress to successful radiographic fusion.

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“…Nine imaging criteria were selected to score the CT scans. These criteria were extracted from prior scientific work 1,6,13,20 and compiled by the senior author (H.K.). They are stated and clarified in Table 1.…”

Section: Ct Imaging Techniquementioning

confidence: 99%

Diagnostic accuracy of CT scan–based criteria compared with surgical exploration for the analysis of cervical fusion and nonunion

Bilsen

Ullrich

Ferraris³

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEComputed tomography (CT) scans are accepted as the imaging standard of reference to define union after anterior cervical discectomy and fusion (ACDF). However, ideal CT criteria to diagnose union have not been identified or validated. The objective of this study was to analyze the diagnostic value of 9 CT-based criteria and identify the ideal criteria among them to assess cervical fusion after ACDF using surgical exploration as the standard of reference.METHODSThe authors performed a retrospective radiographic study of a single surgeon’s prospective assessment of osseous fusion during cervical revision surgery by analyzing complete radiographic data in 44 patients who underwent anterior cervical revision surgery due to symptomatic suspected nonunion or adjacent level disease. All patients received standard preoperative CT scans, which were assessed by an independent radiologist to evaluate 9 diagnostic criteria for osseous union. During revision surgery, scar tissue was removed and manual segmental translation tests were performed. Nonunion was defined by visualized motion at the treated ACDF level.RESULTSIn total, 44 patients were included in the study (30 men; patient age 54 ± 6 years, BMI 28 ± 5 kg/m2). For analysis of fusion, 75 cervical levels were explored, of which 61 levels (81%) showed intraoperative movement indicating nonunion. Statistical analysis showed that of the 9 parameters used to diagnose bone union, “bridging bone on ≥ 3 CT slices” yielded the highest sensitivity (100%) and specificity (58%). Multivariate analysis revealed that prediction accuracy was not increased if several criteria were combined to determine fusion.CONCLUSIONSThe authors found that the best indicator of bone union was the item bridging bone on ≥ 3 CT slices. Combining the scoring of more than one criterion did not increase the diagnostic accuracy.

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Radiological Fusion Criteria of Postoperative Anterior Cervical Discectomy and Fusion: A Systematic Review

Cited by 66 publications

References 74 publications

Long-term outcome following three-level stand-alone anterior cervical discectomy and fusion: Is plating necessary?

Long-term outcome following three-level stand-alone anterior cervical discectomy and fusion: Is plating necessary?

Long-Term Radiographic and Functional Outcomes of Patients With Absence of Radiographic Union at 2 Years After Single-Level Anterior Cervical Discectomy and Fusion

Diagnostic accuracy of CT scan–based criteria compared with surgical exploration for the analysis of cervical fusion and nonunion

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