Reliability of clinical measurement for assessing spinal fusion: An experimental sheep study
Sugiyama, Sadahiro, Wullschleger, M.E., Wilson, K., Williams, R., & Goss, B. (2012) Reliability of clinical measurement for assessing spinal fusion: An experimental sheep study. Spine, 37(9), pp. 763-768.
Study Design. A sheep study designed to compare the accuracy of static radiographs, dynamic radiographs, and computed tomographic (CT) scans for the assessment of thoracolumbar facet joint fusion as determined by micro-CT scanning. Objective. To determine the accuracy and reliability of conventional imaging techniques in identifying the status of thoracolumbar (T13-L1) facet joint fusion in a sheep model. Summary of Background Data. Plain radiographs are commonly used to determine the integrity of surgical arthrodesis of the thoracolumbar spine. Many previous studies of fusion success have relied solely on postoperative assessment of plain radiographs, a technique lacking sensitivity for pseudarthrosis. CT may be a more reliable technique, but is less well characterized. Methods. Eleven adult sheep were randomized to either attempted arthrodesis using autogenous bone graft and internal fixation (n = 3) or intentional pseudarthrosis (IP) using oxidized cellulose and internal fixation (n = 8). After 6 months, facet joint fusion was assessed by independent observers, using (1) plain static radiography alone, (2) additional dynamic radiographs, and (3) additional reconstructed spiral CT imaging. These assessments were correlated with high-resolution micro-CT imaging to predict the utility of the conventional imaging techniques in the estimation of fusion success. Results. The capacity of plain radiography alone to correctly predict fusion or pseudarthrosis was 43% and was not improved using plain radiography and dynamic radiography with also a 43% accuracy. Adding assessment by reformatted CT imaging to the plain radiography techniques increased the capacity to predict fusion outcome to 86% correctly. The sensitivity, specificity, and accuracy of static radiography were 0.33, 0.55, and 0.43, respectively, those of dynamic radiography were 0.46, 0.40, and 0.43, respectively, and those of radiography plus CT were 0.88, 0.85, and 0.86, respectively. Conclusion. CT-based evaluation correlated most closely with high-resolution micro-CT imaging. Neither plain static nor dynamic radiographs were able to predict fusion outcome accurately. © 2012 Lippincott Williams & Wilkins.
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|Item Type:||Journal Article|
|Additional Information:||Export Date: 16 May 2012
Language of Original Document: English
Correspondence Address: Goss, B.; Queensland University of Technology, Institute of Health and Biomedical Innovation, 60 Musk Avenue Kelvin Grove, Brisbane, QLD 4059, Australia; email: email@example.com
References: Albee, F.H., Transplantation of a portion of tibia into spine for Pott's disease: A preliminary report (1911) JAMA, 57, pp. 885-886; Hibbs, R.A., Risser, J.C., Treatment of vertebral tuberculosis by spine fusion operation (1928) J Bone Jt Surg Am Vol, 10, pp. 805-815; Vaccaro, A.R., Patel, T., Fischgrund, J., Anderson, D.G., Truumees, E., Herkowitz, H.N., Phillips, F., McCulloch, J.A., A pilot study evaluating the safety and efficacy of OP-1 Putty (rhBMP-7) as a replacement for iliac crest autograft in posterolateral lumbar arthrodesis for degenerative spondylolisthesis (2004) Spine, 29 (17), pp. 1885-1892. , DOI 10.1097/01.brs.0000137062.79201.98; Johnsson, R., Stromqvist, B., Aspenberg, P., Randomized radiostereometric study comparing osteogenic protein-1 (BMP-7) and autograft bone in human noninstrumented posterolateral lumbar fusion: 2002 Volvo award in clinical studies (2002) Spine, 27 (23), pp. 2654-2661. , DOI 10.1097/00007632-200212010-00004; Boden, S.D., Kang, J., Sandhu, H., Heller, J.G., Use of recombinant human bone morphogenetic protein-2 to achieve posterolateral lumbar spine fusion in humans: A prospective, randomized clinical pilot trial 2002 volvo award in clinical studies (2002) Spine, 27 (23), pp. 2662-2673. , DOI 10.1097/00007632-200212010-00005; Kanayama, M., Hashimoto, T., Shigenobu, K., A prospective randomized study of posterolateral lumbar fusion using osteogenic protein-1 (OP-1) versus local autograft with ceramic bone substi-tute: Emphasis of surgical exploration and histologic assessment (2006) Spine (Phila Pa 1976), 31, pp. 1067-1074; Santos, E.R.G., Goss, D.G., Morcom, R.K., Fraser, R.D., Radiologic assessment of interbody fusion using carbon fiber cages (2003) Spine, 28 (10), pp. 997-1001. , DOI 10.1097/00007632-200305150-00007; Assiri, I., Du Plessis, S., Hurlbert, J., A prospective randomized clinical study comparing instrumented lumbar fusion rates of recombinant human-bone morphogenetic protein-2 (rhBMP-2) with autogenous iliac crest bone graft in patients with symptom-atic degenerative disk disease. Calgary experience. (Abstract) (2004) Can J Surg, 47 (SUPPL.), pp. 7-8; Dimar, J.R., Glassman, S.D., Burkus, K.J., Carreon, L.Y., Clinical outcomes and fusion success at 2 years of single-level instrumented posterolateral fusions with recombinant human bone morphogenetic protein-2/compression resistant matrix versus iliac crest bone graft (2006) Spine, 31 (22), pp. 2534-2539. , DOI 10.1097/01.brs.0000240715.78657.81, PII 0000763220061015000005; Glassman, S.D., Dimar, J.R., Burkus, K., Hardacker, J.W., Pryor, P.W., Boden, S.D., Carreon, L.Y., The efficacy of rhBMP-2 for posterolateral lumbar fusion in smokers (2007) Spine, 32 (15), pp. 1693-1698. , DOI 10.1097/BRS.0b013e318074c366, PII 0000763220070701000021; Cooper, D.M., Erickson, B., Peele, A.G., Visualization of 3D osteon morphology by synchrotron radiation micro-CT (2011) J Anat, 219, pp. 481-489; McAfee, P.C., Brantigan, J.W., Fraser, R.D., Kuslich, S.D., Oxland, T.R., Panjabi, M.M., Ray, C.D., Oxland, T., Symposium: A critical discrepancy - A criteria of successful arthrodesis following interbody spinal fusions (2001) Spine, 26 (3), pp. 320-334. , DOI 10.1097/00007632-200102010-00020; Carreon, L.Y., Glassman, S.D., Reliability and agreement between fine-cut CT scans and plain radiography in the evaluation of posterolat-eral fusions (2007) Spine J, 7, pp. 39-44; Carreon, L.Y., Glassman, S.D., Schwender, J.D., Reliability and accuracy of fine-cut computed tomography scans to determine the status of anterior interbody fusions with metallic cages (2008) Spine J, 8, pp. 998-1002; Fogel, G.R., Toohey, J.S., Neidre, A., Brantigan, J.W., Fusion assessment of posterior lumbar interbody fusion using radiolucent cages: X-ray films and helical computed tomography scans compared with surgical exploration of fusion (2008) Spine Journal, 8 (4), pp. 570-577. , DOI 10.1016/j.spinee.2007.03.013, PII S152994300700126X; Ploumis, A., Mehbod, A., Garvey, T., Gilbert, T., Transfeldt, E., Wood, K., Prospective assessment of cervical fusion status: Plain radiographs versus CT-scan (2006) Acta Orthopaedica Belgica, 72 (3), pp. 342-346; Kanayama, M., Cunningham, B.W., Setter, T.J.C., Goldstein, J.A., Stewart, G., Kaneda, K., McAfee, P.C., Does spinal instrumentation influence the healing process of posterolateral spinal fusion? An in vivo animal model (1999) Spine, 24 (11), pp. 1058-1065. , DOI 10.1097/00007632-199906010-00003; Slivka, M.A., Spenciner, D.B., Seim, H.B., Welch, W.C., Serhan, H.A., Turner, A.S., High rate of fusion in sheep cervical spines following anterior interbody surgery with absorbable and nonabsorbable implant devices (2006) Spine, 31 (24), pp. 2772-2777. , DOI 10.1097/01.brs.0000245935.69927.a1, PII 0000763220061115000004; Baramki, H.G., Steffen, T., Lander, P., Chang, M., Marchesi, D., The efficacy of interconnected porous hydroxyapatite in achieving posterolateral lumbar fusion in sheep (2000) Spine, 25 (9), pp. 1053-1060. , DOI 10.1097/00007632-200005010-00003; Walsh, W.R., Harrison, J., Loefler, A., Martin, T., Van Sickle, D., Brown, M.K.C., Sonnabend, D.H., Mechanical and histologic evaluation of Collagraft® in an ovine lumbar fusion model (2000) Clinical Orthopaedics and Related Research, (375), pp. 258-266; Kroner, A.H., Eyb, R., Lange, A., Lomoschitz, K., Mahdi, T., Engel, A., Magnetic resonance imaging evaluation of posterior lumbar interbody fusion (2006) Spine, 31 (12), pp. 1365-1371. , DOI 10.1097/01.brs.0000218583.43398.e3, PII 0000763220060520000016; Carreon, L.Y., Djurasovic, M., Glassman, S.D., Sailer, P., 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 (2007) Spine, 32 (8), pp. 892-895. , DOI 10.1097/01.brs.0000259808.47104.dd, PII 0000763220070415000011
|Keywords:||CT scan, facet joint fusion, pseudarthrosis, reliability|
|Subjects:||Australian and New Zealand Standard Research Classification > ENGINEERING (090000) > MECHANICAL ENGINEERING (091300)|
|Divisions:||Current > Schools > School of Chemistry, Physics & Mechanical Engineering
Current > Institutes > Institute of Health and Biomedical Innovation
Current > QUT Faculties and Divisions > Science & Engineering Faculty
|Copyright Owner:||Copyright 2012 Lippincott, Williams & Wilkins|
|Deposited On:||17 May 2012 01:42|
|Last Modified:||12 Jun 2013 14:47|
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