Assessment of bone graft incorporation by 18 F-fluoride positron-emission tomography/computed tomography in patients with persisting symptoms after posterior lumbar interbody fusion
Assessment of bone graft incorporation by 18 F-fluoride positron-emission tomography/computed tomography in patients with persisting symptoms after posterior lumbar interbody fusion
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DOI：
10.1186/2191-219x-2-42
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发表时间：
2012-01-01
期刊：
影响因子：
3.2
通讯作者：
Willems, Paul
中科院分区：
文献类型：
--
作者：
Brans, Boudewijn;Weijers, Rene;Willems, Paul
背景资料：后路腰椎椎体间融合术（PLIF）是一种通过椎板切除术对椎管和神经根进行减压，并通过填充植骨和椎弓根螺钉固定的椎间融合器进行融合的方法。传统的成像技术，如普通X线摄影和计算机断层扫描（CT），有局限性，以评估骨融合dynamics.Methods：在16 PLIF的15例持续症状，正电子发射断层扫描（PET）/CT扫描后60分钟静脉注射156至263 MBq的（18）F-氟化物，包括1毫米切片，高剂量，非对比增强CT扫描。最大标准摄取值（SUVmax）的各个区域进行了计算，并与异常CT。结果：沉降的笼到椎体终板是最常见的异常CT（在16 27或59%的可评价终板）。与没有下沉的患者相比，有明显（p <0.0001）或中度（p <0.013）下沉的患者的终板SUVmax值显著更高。此外，发现椎体和同侧椎弓根螺钉入口SUVmax值之间存在显著相关性（p <0.009），可能表明骨应力增加的后方传递。在我们的患者组中，椎体间融合被认为是在CT上的63%，但没有表现出相关性椎体间SUVmax values.Conclusions：使用（18）F-氟化物PET/CT，椎间融合器下沉似乎是一个突出的发现，在这个病人组的持续症状，并高度相关的PET活动过度的程度在椎体终板和椎弓根螺钉入口点。使用18F-氟化物PET/CT的进一步研究应特别评估前瞻性患者组中代谢活性下沉的作用，以解决其在骨不连中的作用以及作为持续疼痛的原因。
Background: Posterior lumbar interbody fusion (PLIF) is a method that allows decompression of the spinal canal and nerve roots by laminectomy combined with fusion by means of intervertebral cages filled with bone graft and pedicle screw fixation. Conventional imaging techniques, such as plain radiography and computed tomography (CT), have limitations to assess bony fusion dynamics.Methods: In 16 PLIFs of 15 patients with persisting symptoms, positron-emission tomography (PET)/CT scans were made 60 min after intravenous administration of 156 to 263 MBq of (18) F-fluoride, including 1-mm sliced, high-dose, non-contrast-enhanced CT scanning. Maximal standard uptake values (SUVmax) of various regions were calculated and correlated with abnormalities on CT.Results: Subsidence of the cages into the vertebral endplates was the most frequently observed abnormality on CT (in 16 of 27 or 59% of evaluable endplates). Endplate SUVmax values were significantly higher for those patients with pronounced (p < 0.0001) or moderate (p < 0.013) subsidence as compared to those with no subsidence. Additionally, a significant correlation between vertebral and ipsilateral pedicle screw entrance SUVmax values (p < 0.009) was found, possibly indicating posterior transmission of increased bone stress. In our patient group, intercorporal fusion was seen on CT in 63% but showed no correlation to intercorporal SUVmax values.Conclusions: With the use of (18) F-fluoride PET/CT, intervertebral cage subsidence appeared to be a prominent finding in this patient group with persisting symptoms, and highly correlating with the degree of PET hyperactivity at the vertebral endplates and pedicle screw entry points. Further study using (18) F-fluoride PET/CT should specifically assess the role of metabolically active subsidence in a prospective patient group, to address its role in nonunion and as a cause of persisting pain.