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Reliability and Utility of Various Methods for Evaluation of Bone Union after Anterior Cervical Discectomy and Fusion

Most surgical procedures performed on account of degenerative disease of the cervical spine involve a discectomy and interbody fixation. Bone fusion at the implant placement site is evaluated post-operatively. It is agreed that computed tomography is the best modality for assessing bone union. We ev...

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Autores principales: Godlewski, Bartosz, Bebenek, Adam, Dominiak, Maciej, Bochniak, Marcin, Cieslik, Piotr, Pawelczyk, Tomasz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9605251/
https://www.ncbi.nlm.nih.gov/pubmed/36294384
http://dx.doi.org/10.3390/jcm11206066
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author Godlewski, Bartosz
Bebenek, Adam
Dominiak, Maciej
Bochniak, Marcin
Cieslik, Piotr
Pawelczyk, Tomasz
author_facet Godlewski, Bartosz
Bebenek, Adam
Dominiak, Maciej
Bochniak, Marcin
Cieslik, Piotr
Pawelczyk, Tomasz
author_sort Godlewski, Bartosz
collection PubMed
description Most surgical procedures performed on account of degenerative disease of the cervical spine involve a discectomy and interbody fixation. Bone fusion at the implant placement site is evaluated post-operatively. It is agreed that computed tomography is the best modality for assessing bone union. We evaluated the results obtained with various methods based solely on conventional radiographs in the same group of patients and compared them with results obtained using a method that is a combination of CT and conventional radiography, which we considered the most precise and a reference method. We operated on a total of 170 disc spaces in a group of 104 patients. Fusion was evaluated at 12 months after surgery with five different and popular classifications based on conventional radiographs and then compared with the reference method. Statistical analyses of test accuracy produced the following classification of fusion assessment methods with regard to the degree of consistency with the reference method, in descending order: (1) bone bridging is visible on the anterior and/or posterior edge of the operated disc space on a lateral radiograph; (2) change in the value of Cobb’s angle for a motion segment on flexion vs. extension radiographs (threshold for fusion vs. pseudoarthrosis is 2°); (3) change in the interspinous distance between process tips on flexion vs. extension radiographs (threshold of 2 mm); (4) change in the value of Cobb’s angle of a motion segment (threshold of 4°); (5) change in the interspinous distance between process bases on flexion vs. extension radiographs (threshold of 2 mm). When bone union is evaluated on the basis on radiographs, without CT evidence, we suggest using the “bone bridging” criterion as the most reliable commonly used approach to assessing bone union.
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spelling pubmed-96052512022-10-27 Reliability and Utility of Various Methods for Evaluation of Bone Union after Anterior Cervical Discectomy and Fusion Godlewski, Bartosz Bebenek, Adam Dominiak, Maciej Bochniak, Marcin Cieslik, Piotr Pawelczyk, Tomasz J Clin Med Article Most surgical procedures performed on account of degenerative disease of the cervical spine involve a discectomy and interbody fixation. Bone fusion at the implant placement site is evaluated post-operatively. It is agreed that computed tomography is the best modality for assessing bone union. We evaluated the results obtained with various methods based solely on conventional radiographs in the same group of patients and compared them with results obtained using a method that is a combination of CT and conventional radiography, which we considered the most precise and a reference method. We operated on a total of 170 disc spaces in a group of 104 patients. Fusion was evaluated at 12 months after surgery with five different and popular classifications based on conventional radiographs and then compared with the reference method. Statistical analyses of test accuracy produced the following classification of fusion assessment methods with regard to the degree of consistency with the reference method, in descending order: (1) bone bridging is visible on the anterior and/or posterior edge of the operated disc space on a lateral radiograph; (2) change in the value of Cobb’s angle for a motion segment on flexion vs. extension radiographs (threshold for fusion vs. pseudoarthrosis is 2°); (3) change in the interspinous distance between process tips on flexion vs. extension radiographs (threshold of 2 mm); (4) change in the value of Cobb’s angle of a motion segment (threshold of 4°); (5) change in the interspinous distance between process bases on flexion vs. extension radiographs (threshold of 2 mm). When bone union is evaluated on the basis on radiographs, without CT evidence, we suggest using the “bone bridging” criterion as the most reliable commonly used approach to assessing bone union. MDPI 2022-10-14 /pmc/articles/PMC9605251/ /pubmed/36294384 http://dx.doi.org/10.3390/jcm11206066 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Godlewski, Bartosz
Bebenek, Adam
Dominiak, Maciej
Bochniak, Marcin
Cieslik, Piotr
Pawelczyk, Tomasz
Reliability and Utility of Various Methods for Evaluation of Bone Union after Anterior Cervical Discectomy and Fusion
title Reliability and Utility of Various Methods for Evaluation of Bone Union after Anterior Cervical Discectomy and Fusion
title_full Reliability and Utility of Various Methods for Evaluation of Bone Union after Anterior Cervical Discectomy and Fusion
title_fullStr Reliability and Utility of Various Methods for Evaluation of Bone Union after Anterior Cervical Discectomy and Fusion
title_full_unstemmed Reliability and Utility of Various Methods for Evaluation of Bone Union after Anterior Cervical Discectomy and Fusion
title_short Reliability and Utility of Various Methods for Evaluation of Bone Union after Anterior Cervical Discectomy and Fusion
title_sort reliability and utility of various methods for evaluation of bone union after anterior cervical discectomy and fusion
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9605251/
https://www.ncbi.nlm.nih.gov/pubmed/36294384
http://dx.doi.org/10.3390/jcm11206066
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