Anterior cervical fusion assessment - Surgical exploration versus radiographic evaluation
Anterior cervical fusion assessment - Surgical exploration versus radiographic evaluation
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DOI：
10.1097/brs.0b013e318171927c
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发表时间：
2008-05-15
期刊：
影响因子：
3
通讯作者：
Riew, K. Daniel
中科院分区：
文献类型：
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作者：
Buchowski, Jacob M.;Liu, Gabriel;Riew, K. Daniel
研究设计。前瞻性临床试验。目的：本前瞻性研究的目的是评估x线平片、计算机断层扫描（CT）和磁共振成像（MRI）检测颈椎前路融合术后假关节的可靠性，并与术中探查相比较。背景资料摘要。尽管颈椎前路融合术已经进行了近50年，但假关节的诊断仍然存在争议，尽管已经描述了各种放射学方法来检测假关节，但没有报告将这些研究与术中探查的金标准进行比较，以确定哪种方法最准确。所有探查均在手术后6个月内进行，并在手术后1个月内进行研究。再手术指征为邻近节段疾病和/或假关节修复。所有的病人都在显微镜下进行了彻底的检查，钩肢对钩肢的检查，必要时切除部分皮质化的移植物。放射学研究由3名不参与患者护理的脊柱外科医生进行盲目和独立的审查。在纳入的14例患者中，8例有假性关节。平片Kappa统计值为0.67（范围：0.51 ~ 0.75,P < 0.05）， CT Kappa统计值为0.81（范围：0.71 ~ 0.87,P < 0.05）， MRI Kappa统计值为0.48（范围：0.32 ~ 0.71,P < 0.05）。当考虑所有研究时，Kappa统计量的平均值增加到0.85（范围：0.71 - 1.00,P < 0.05）。对配对观察者间信度的评估显示，x线平片的平均Kappa统计量为0.46（范围，0.31 - 0.55,P < 0.05）， CT为0.82（范围，0.73 - 0.87,P < 0.05）， MRI为0.32（范围，0.21 - 0.40,P < 0.05）。当考虑所有放射学研究时，配对观察者间信度平均Kappa统计量为0.70（范围0.55 - 0.85,P < 0.05）。我们的结果表明，CT与术中表现最为吻合。因此，我们建议在任何依赖融合状态评估的研究中使用CT。然而，重要的是要记住，即使是CT也不是100%准确。
Study Design. Prospective clinical trial.Objective. The goal of this prospective study was to assess the reliability of plain radiographs, computed tomography ( CT), and magnetic resonance imaging ( MRI) to detect a pseudarthrosis after an anterior cervical fusion compared with intraoperative exploration.Summary of Background Data. Although anterior cervical fusions have been performed for > 50 years, diagnosis of pseudarthrosis remains controversial, and even though various radiologic methods have been described to detect a pseudarthosis, no reports have compared these studies against the gold standard of intraoperative exploration to determine which is most accurate.Methods. All explorations were performed > 6 months after the index procedure and studies were obtained within a month of surgery. Indications for reoperation were adjacent level disease and/ or pseudarthrosis repair. All patients were thoroughly explored using a microscope, uncinate- to- uncinate exploration, and if necessary, removal of part of the corticalized graft. Radiologic studies were blindly and independently reviewed by 3 spine surgeons uninvolved in the care of the patients.Results. Of the 14 patients included, 8 had pseudarthroses. Assessment of the agreement between intraoperative and radiographic findings revealed a mean Kappa statistic of 0.67 ( range, 0.51 - 0.75, P < 0.05) for plain radiographs, 0.81 ( range, 0.71 - 0.87, P < 0.05) for CT, and 0.48 ( range, 0.32 - 0.71, P < 0.05) for MRI. When all studies were taken into consideration, the mean Kappa statistic increased to 0.85 ( range, 0.71 - 1.00, P < 0.05). Assessment of paired interobserver reliability revealed a mean Kappa statistic of 0.46 ( range, 0.31 - 0.55, P < 0.05) for plain radiographs, 0.82 ( range, 0.73 - 0.87, P < 0.05) for CT, and 0.32 ( range, 0.21 - 0.40, P < 0.05) for MRI. When all radiographic studies were taken into consideration, paired interobserver reliability had a mean Kappa statistic of 0.70 ( range, 0.55 - 0.85, P < 0.05).Conclusion. Our results indicate that CT most closely agrees with intraoperative findings. We therefore recommend that CT be used in any study that relies on fusion status assessment. It is important to remember, however, that even CT is not 100% accurate.