Fusion assessment of posterior lumbar interbody fusion using radiolucent cages: X-ray films and helical computed tomography scans compared with surgical exploration of fusion
Fusion assessment of posterior lumbar interbody fusion using radiolucent cages: X-ray films and helical computed tomography scans compared with surgical exploration of fusion
复制标题
DOI：
10.1016/j.spinee.2007.03.013
复制
发表时间：
2008-07-01
期刊：
影响因子：
4.5
通讯作者：
Brantigan, John W.
中科院分区：
文献类型：
--
作者：
Fogel, Guy R.;Toohey, John S.;Brantigan, John W.
背景技术背景：据报道，只有三分之二的患者在手术探查时愈合，后外侧融合的平片评估准确。据报道，使用放射性椎间融合器进行椎间融合的融合评估的平片影像学技术是准确的。与X线平片相比，螺旋CT扫描对假关节的诊断具有较高的敏感性。目的：通过与融合手术探查结果的比较，确定X线平片和螺旋CT扫描对融合评估的准确性。X线平片和薄片的准确性和观察者间一致性对使用射线可透碳纤维增强聚合物融合器（CFRP）和髂嵴植骨进行后路腰椎椎间融合的患者，将螺旋CT断层扫描与手术探查的融合评估进行比较。患者样本：回顾性分析90例腰椎融合手术探查的患者。结果：所有患者均行X线平片，包括Ferguson前后平行于椎间间隙。54例患者进行了薄层螺旋CT扫描。方法：通过探索融合评估与通过平片和CT扫描进行盲法评估进行比较。结果：90例患者进行了172个腰椎椎间融合和后外侧融合节段的手术探查。在探查时，90名患者中的87名和172个融合节段中的168个（97%）融合成功。X线片评估显示87%的椎间融合愈合，75%的后外侧融合愈合。椎体间融合的CT分级发现77%的椎体间融合愈合，68%的后外侧融合愈合。X线平片和CT扫描对假关节的敏感性为100%，对愈合融合的阴性预测值为100%。特异性几乎是90%，X线片和CT scanns.CONCLUSIONS之间没有显着差异：融合评估与普通X线片和螺旋CT扫描显示后腰椎椎间融合手术探查证实的准确性相同。我们的研究结果表明，当平片显示融合或假关节的有力证据时，螺旋CT不太可能提供有用的新信息。(C)2008年爱思唯尔公司所有的战斗保留。
BACKGROUND: Plain radiographic assessment of posterolateral fusion has been reported as accurate in only two thirds of patients who were found to be healed at surgical exploration. Plain radiographic techniques for fusion assessment of interbody fusion with radiolucent cages are reported to be accurate. A helical computed tomography (CT) scan shows a high sensitivity for pseudarthrosis compared with plain radiography.PURPOSE: To determine the accuracy of fusion assessment with plain X-ray films and helical CT scans by comparison to results of surgical exploration of fusion.STUDY DESIGN/SETTING: The accuracy and interobserver agreement of plain X-ray films and thin-cut helical CT scans were compared with fusion assessment by surgical exploration in patients with posterior lumbar interbody fusion using a radiolucent carbon fiber reinforced polymer cage (CFRP) and iliac crest bone graft.PATIENT SAMPLE: A review of 90 patients who had surgical exploration of the lumbar fusion.OUTCOME MEASURES: All patients had plain X-ray films including Ferguson anteroposterior parallel to the interbody space. Fifty-four patients had thin-section helical CT scans.METHODS: Fusion assessment by exploration was compared with blinded assessment by plain X-ray films and CT scans.RESULTS: Ninety patients had surgical exploration of 172 lumbar interbody and posterolateral fusion levels. At the time of exploration, fusion was determined to be successful in 87 of 90 patients and 168 of 172 (97%) fusion levels. X-ray assessment showed healed interbody fusions in 87% and posterolateral fusion healed in 75%. CT grading of the interbody fusion found healed interbody fusion in 77%, and the posterolateral fusion was fused in 68%. Plain X-ray films and CT scans had a sensitivity of 100% for pseudarthrosis and a negative predictive value of 100% for healed fusion. Specificity was almost 90% and was not significantly different between X-ray films and CT scans.CONCLUSIONS: Fusion assessment with plain X-ray films and helical CT scans showed equal accuracy after posterior lumbar interbody fusion confirmed by surgical exploration. Our results indicate that when plain X-ray films show strong evidence of fusion or pseudarthrosis, the helical CT is unlikely to provide useful new information. (C) 2008 Elsevier Inc. All fights reserved.