Reliability of clinical measurement for assessing spinal fusion: An experimental sheep study

Sugiyama, Sadahiro, Wullschleger, Martin E., Wilson, Kathleen, Williams, Richard and Goss, Ben (2012) Reliability of clinical measurement for assessing spinal fusion: An experimental sheep study. Spine, 37 9: 763-768. doi:10.1097/BRS.0b013e31822ffa05

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Author Sugiyama, Sadahiro
Wullschleger, Martin E.
Wilson, Kathleen
Williams, Richard
Goss, Ben
Title Reliability of clinical measurement for assessing spinal fusion: An experimental sheep study
Journal name Spine   Check publisher's open access policy
ISSN 0362-2436
1528-1159
Publication date 2012
Year available 2011
Sub-type Article (original research)
DOI 10.1097/BRS.0b013e31822ffa05
Volume 37
Issue 9
Start page 763
End page 768
Total pages 6
Place of publication Philadelphia, PA, U.S.A.
Publisher Lippincott Williams & Wilkins
Collection year 2012
Language eng
Formatted abstract
Study Design. A sheep study designed to compare the accuracy of static radiographs, dynamic radiographs and computed tomography (CT) 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 employed 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. Computerised tomography may be a more reliable technique but is less well characterised.

Methods. Eleven adult sheep were randomised to either attempted arthrodesis using autogenous bone graft and internal fixation (n = 3) or interposition pseudarthrosis (IP) using oxidised 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 in order 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 correctly predict fusion outcome to 86%. The sensitivity, specificity and accuracy of static radiography were 0.33, 0.55 and 0.43. Those of dynamic radiography were 0.46, 0.40 and 0.43. Those of radiography plus CT scan were 0.88, 0.85 and 0.86.

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.
Keyword CT scan
Facet joint fusion
Pseudarthrosis
Reliability
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ
Additional Notes Online Ahead of Print 2 September 2011

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
 
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Created: Tue, 01 Nov 2011, 18:34:43 EST by Martin Wullschleger on behalf of Surgery - Royal Brisbane and Women's Hospital