Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: Radiographic assessment of fusion status

Journal of Neurosurgery: Spine - Tập 21 Số 1 - Trang 23-30 - 2014
Tanvir F. Choudhri1, Praveen V. Mummaneni2, Sanjay S. Dhall2, Jason C. Eck3, Michael W. Groff4, Zoher Ghogawala5, William C. Watters6, Andrew T. Dailey7, Daniel K. Resnick8, Alok Sharan9, Jeffrey C. Wang10, Michael G. Kaiser11
1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
2Department of Neurological Surgery, University of California, San Francisco, California
3Center for Sports Medicine and Orthopaedics, Chattanooga, Tennessee;
4Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
5Alan and Jacqueline Stuart Spine Research Center, Department of Neurosurgery, Lahey Clinic, Burlington, and Tufts University School of Medicine, Boston, Massachusetts;
6Bone and Joint Clinic of Houston, Texas;
7Department of Neurosurgery, University of Utah, Salt Lake City, Utah
8Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin;
9Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
10Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; and
11Department of Neurosurgery, Columbia University, New York, New York

Tóm tắt

The ability to identify a successful arthrodesis is an essential element in the management of patients undergoing lumbar fusion procedures. The hypothetical gold standard of intraoperative exploration to identify, under direct observation, a solid arthrodesis is an impractical alternative. Therefore, radiographic assessment remains the most viable instrument to evaluate for a successful arthrodesis. Static radiographs, particularly in the presence of instrumentation, are not recommended. In the absence of spinal instrumentation, lack of motion on flexion-extension radiographs is highly suggestive of a successful fusion; however, motion observed at the treated levels does not necessarily predict pseudarthrosis. The degree of motion on dynamic views that would distinguish between a successful arthrodesis and pseudarthrosis has not been clearly defined. Computed tomography with fine-cut axial images and multiplanar views is recommended and appears to be the most sensitive for assessing fusion following instrumented posterolateral and anterior lumbar interbody fusions. For suspected symptomatic pseudarthrosis, a combination of techniques including static and dynamic radiographs as well as CT images is recommended as an option. Lack of facet fusion is considered to be more suggestive of a pseudarthrosis compared with absence of bridging posterolateral bone. Studies exploring additional noninvasive modalities of fusion assessment have demonstrated either poor potential, such as with 99mTc bone scans, or provide insufficient information to formulate a definitive recommendation.

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Tài liệu tham khảo

Blumenthal, 1993, Can lumbar spine radiographs accurately determine fusion in postoperative patients? Correlation of routine radiographs with a second surgical look at lumbar fusions, 18, 1186, 10.1097/00007632-199307000-00010

Bohnsack, 1999, The value of scintigraphy in the diagnosis of pseudarthrosis after spinal fusion surgery, 12, 482

Brodsky, 1991, Correlation of radiologic assessment of lumbar spine fusions with surgical exploration, 16, S261, 10.1097/00007632-199106001-00017

Burkus, 2003, Radiographic assessment of interbody fusion using recombinant human bone morphogenetic protein type 2, 28, 372, 10.1097/01.BRS.0000048469.45035.B9

Carreon, 2007, Diagnostic accuracy and reliability of fine-cut CT scans with reconstructions to determine the status of an instrumented posterolateral fusion with surgical exploration as reference standard, 32, 892, 10.1097/01.brs.0000259808.47104.dd

Carreon, 2008, Fusion and nonsurgical treatment for symptomatic lumbar degenerative disease: a systematic review of Oswestry Disability Index and MOS Short Form-36 outcomes, 8, 747, 10.1016/j.spinee.2007.06.013

Carreon, 2008, Reliability and accuracy of fine-cut computed tomography scans to determine the status of anterior interbody fusions with metallic cages, 8, 998, 10.1016/j.spinee.2007.12.004

Chafetz, 1987, Pseudarthrosis following lumbar fusion: detection by direct coronal CT scanning, 162, 803, 10.1148/radiology.162.3.3809497

Cleveland, 1948, Pseudarthrosis in the lumbosacral spine, 30A, 302

Fogel, 2008, Fusion assessment of posterior lumbar interbody fusion using radiolucent cages: X-ray films and helical computed tomography scans compared with surgical exploration of fusion, 8, 570, 10.1016/j.spinee.2007.03.013

Hilibrand, 1998, The use of diagnostic imaging to assess spinal arthrodesis, 29, 591, 10.1016/S0030-5898(05)70033-X

Jacobson, 1997, Pseudarthrosis: US evaluation after posterolateral spinal fusion: work in progress, 204, 853, 10.1148/radiology.204.3.9280271

Johnsson, 1999, Stability of lumbar fusion with transpedicular fixation determined by roentgen stereophotogrammetric analysis, 24, 687, 10.1097/00007632-199904010-00014

Johnsson, 1990, Mobility of the lower lumbar spine after posterolateral fusion determined by roentgen stereophotogrammetric analysis, 15, 347, 10.1097/00007632-199005000-00001

Kant, 1995, Evaluation of lumbar spine fusion. Plain radiographs versus direct surgical exploration and observation, 20, 2313, 10.1097/00007632-199511000-00009

Laasonen, 1989, Low-back pain after lumbar fusion. Surgical and computed tomographic analysis, 14, 210, 10.1097/00007632-198902000-00011

Lang, 1990, Lumbar spinal fusion. Assessment of functional stability with magnetic resonance imaging, 15, 581, 10.1097/00007632-199006000-00028

Lang, 1988, Threedimensional computed tomography and multiplanar reformations in the assessment of pseudarthrosis in posterior lumbar fusion patients, 13, 69, 10.1097/00007632-198801000-00017

Larsen, 1996, Assessment of pseudarthrosis in pedicle screw fusion: a prospective study comparing plain radiographs, flexion/extension radiographs, CT scanning, and bone scintigraphy with operative findings, 9, 117

McAfee, 2001, Symposium: a critical discrepancy-a criteria of successful arthrodesis following interbody spinal fusions, 26, 320, 10.1097/00007632-200102010-00020

Pape, 2002, Lumbosacral stability of consolidated anteroposterior fusion after instrumentation removal determined by roentgen stereophotogrammetric analysis and direct surgical exploration, 27, 269, 10.1097/00007632-200202010-00014

Resnick, 2005, Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: radiographic assessment of fusion, 2, 653, 10.3171/spi.2005.2.6.0653

Santos, 2003, Radiologic assessment of interbody fusion using carbon fiber cages, 28, 997, 10.1097/01.BRS.0000061988.93175.74

Shah, 2003, Comparison of plain radiographs with CT scan to evaluate interbody fusion following the use of titanium interbody cages and transpedicular instrumentation, 12, 378, 10.1007/s00586-002-0517-4

Siambanes, 1998, Comparison of plain radiographs and CT scans in instrumented posterior lumbar interbody fusion, 21, 165, 10.3928/0147-7447-19980201-09

Zinreich, 1990, Three-dimensional CT imaging in postsurgical “failed back” syndrome, 14, 574

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Journal of Neurosurgery: Spine

Tập 21 Số 1

23-30

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