The value of 18F-fluoride PET/CT in the assessment of screw loosening in patients after intervertebral fusion stabilization

Seifen, Tanja; Rodrigues, Margarida; Rettenbacher, Lukas; Piotrowski, W.; Holzmannhofer, J.; Coy, Mark Mc; Pirich, Christian

doi:10.1007/s00259-014-2904-6

Cited by 11 publications

(10 citation statements)

References 20 publications

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“…An increased uptake has also been registered in other studies of cases with screw-loosening with a specificity of 97.4% in patient-based analysis [ 40 ]. A relationship with painful pseudarthrosis was suggested by Peters et al in a retrospective series of 36 patients, because after surgery 18F-NaF activity was reported to be significantly higher in patients with worse functional scores [ 41 ]. Abnormal foci of uptake appear to be related to the patient’s source of pain and could be located at various sites involved in arthrodesis (cages, screws, rods, or bone grafts) helping surgeons to choose the best management and strategy if a surgical revision is considered mandatory [ 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…In this series, implant stability and fusion were finally confirmed by radiological exams (X-rays of CT), helping us to adequately validate our results. As described by previous studies, the presence of pseudarthrosis, subsidence, or implants loosening could result in abnormal uptake, increasing over time and helping to discriminate between asymptomatic and symptomatic cases requiring revision [ 41 , 42 , 43 ]. According with our preliminary results [ 36 ], the use of custom-made TTCs is confirmed to represent a promising approach in order to achieve good stability promoting active osteo-integration and fusion, while minimizing subsidence rates.…”

Section: Discussionmentioning

confidence: 99%

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The Efficacy of Trabecular Titanium Cages to Induce Reparative Bone Activity after Lumbar Arthrodesis Studied through the 18f-Naf PET/CT Scan: Observational Clinical In-Vivo Study

et al. 2022

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Background: Titanium trabecular cages (TTCs) are emerging implants designed to achieve immediate and long-term spinal fixation with early osseointegration. However, a clear radiological and clinical demonstration of their efficacy has not yet been obtained. The purpose of this study was to evaluate the reactive bone activity of adjacent plates after insertion of custom-made titanium trabecular cages for the lumbar interbody with positron emission tomography (PET)/computed tomography (CT) 18F sodium fluoride (18F-NaF). Methods: This was an observational clinical study that included patients who underwent surgery for degenerative disease with lumbar interbody fusion performed with custom-made TTCs. Data related to the metabolic-reparative reaction following the surgery and its relationship with clinical follow-up from PET/CT performed at different weeks were evaluated. PET/CTs provided reliable data, such as areas showing abnormally high increases in uptake using a volumetric region of interest (VOI) comprising the upper (UP) and lower (DOWN) limits of the cage. Results: A total of 15 patients was selected for PET examination. Timing of PET/CTs ranged from one week to a maximum of 100 weeks after surgery. The analysis showed a negative correlation between the variables SUVmaxDOWN/time (r = −0.48, p = 0.04), ratio-DOWN/time (r = −0.53, p = 0.02), and ratio-MEAN/time (r = −0.5, p = 0.03). Shapiro−Wilk normality tests showed significant results for the variables ratio-DOWN (p = 0.002), ratio-UP (0.013), and ratio-MEAN (0.002). Conclusions: 18F-NaF PET/CT has proven to be a reliable tool for investigating the metabolic-reparative reaction following implantation of TTCs, demonstrating radiologically how this type of cage can induce reparative osteoblastic activity at the level of the vertebral endplate surface. This study further confirms how electron-beam melting (EBM)-molded titanium trabecular cages represent a promising material for reducing hardware complication rates and promoting fusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Efficacy of Trabecular Titanium Cages to Induce Reparative Bone Activity after Lumbar Arthrodesis Studied through the 18f-Naf PET/CT Scan: Observational Clinical In-Vivo Study

et al. 2022

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“…However, CT scan is still the only accepted method in literature to evaluate osseous progression after spinal fusion surgery, to determine screw positions, to confirm the integrity of instrumentation elements, to detect suspicious complications, to investigate new disease and / or disease progression (5,8,13,14). It is believed that the screw loosening aetiology is multifactorial and may depend on the patient characteristics (such as age, gender, weight bearing), strength type of screws, operation technique, and the length of the spinal segments to be fused (5,8,15). Indeed, On the other hand, screw loosening is thought to occur most frequently in patients with thoracolumbar posterior instrumentation (4,18,19,20).…”

Section: Discussionmentioning

confidence: 99%

Potential risk factors in development of the “halo sign” in patients performed transpedicular screw fixation through the posterior spinal approach.

Öğden¹,

Yüksel²,

Akkurt³

et al. 2019

Osmangazi̇ Journal of Medicine

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It has been shown in literature that a fibrous tissue called "halo sign" in the radiological terminology can develop around the transpedicular screws implanted incompletely and/or incorrectly, which appears after movement of the screw in the cancellous bone. In this retrospective clinical study, 141 patients who underwent posterior spinal instrumentation for thoracic, lumbar or thoracolumbar vertebrae were evaluated using computed tomography (CT) and direct X-rays images for "halo sign" formation which refers in probable failure of spinal instrumentation. Hospital records included in the year 2014-2018 were examined and adult patients who were performed lumbar, thoracal, and thoracolumbar spinal instrumentation via posterior approach due to reasons such as "spine fracture", "spondylosis", "spondylolisthesis" and "intervertebral disc hernia" were included and evaluated in this study. The age and sex of the patients were recorded. Spinal X-ray and spinal CT images obtained during the postoperative follow-up period were examined. Halo sign was seen in 13 patients. Age (p=0.013), number of instrumented vertebrae (p=0.001) and number of transpedicular screws (p<0.001) values were different between the patients with halo sign and patients without halo sign. As a result, it was observed in this study that the formation of the halo sign in posterior spinal instrumentation system could develop in proportion to the number of transpedicular screw and patients' age. It was thought that the halo sign formation was not connected with the parameters called performed laminectomy, gender, inserted intervertebral cage, or vertebral region which were inserted transpedicular screws.

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“…121 Spinal orthopedics is another area that may benefit from NaF-PET, which may have a role in predicting healing and identifying complications such as nonunion, pseudarthrosis, infection, and hardware loosening. [126][127][128][129][130][131] In pediatrics, Grant 27 reported utility in determining the cause of pain in children who underwent spinal fusion surgery for scoliosis. Fischer and colleagues 132 studied 20 patients who underwent cervical or lumbar intercorporal fusion and found that increased NaF activity could be visualized in cervical cages for up to 8 years after intervention and up to 10 years in lumbar cages (Fig.…”

Section: Orthopedic Complicationsmentioning

confidence: 99%

Novel Musculoskeletal and Orthopedic Applications of 18F-Sodium Fluoride PET

et al. 2021

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The bone-seeking properties of 18 F-sodium fluoride (NaF) were first described in 1962 by Blau and colleagues, 1 who used this positron-emitting radiotracer in skeletal scintigraphy. Both high uptake by bone and rapid plasma clearance of NaF were determined to be advantages in imaging skeletal metabolism. 2 The mechanism of NaF uptake relies on the exchange of OH À for 18 F À , converting hydroxyapatite on the surface of the bone matrix to fluorapatite. 2,3 One hour after NaF is administered intravenously, only 10% remains in the plasma compartment because of a first-pass Conflict of interest: The authors have declared no conflicts of interest.

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The value of 18F-fluoride PET/CT in the assessment of screw loosening in patients after intervertebral fusion stabilization

Abstract: (18)F-Fluoride PET/CT imaging is useful for the diagnosis of screw loosening in patients with persistent symptoms after intervertebral fusion stabilization.

Cited by 11 publications

References 20 publications

The Efficacy of Trabecular Titanium Cages to Induce Reparative Bone Activity after Lumbar Arthrodesis Studied through the 18f-Naf PET/CT Scan: Observational Clinical In-Vivo Study

The Efficacy of Trabecular Titanium Cages to Induce Reparative Bone Activity after Lumbar Arthrodesis Studied through the 18f-Naf PET/CT Scan: Observational Clinical In-Vivo Study

Potential risk factors in development of the “halo sign” in patients performed transpedicular screw fixation through the posterior spinal approach.

Novel Musculoskeletal and Orthopedic Applications of 18F-Sodium Fluoride PET

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