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Michael G. Kaiser, Praveen V. Mummaneni, Paul G. Matz, Paul A. Anderson, Michael W. Groff, Robert F. Heary, Langston T. Holly, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. Vresilovic, and Daniel K. Resnick

least Class III medical evidence are listed in Table 1 . A complete list of the manuscripts chosen from the search is contained in the References . TABLE 1: Evidentiary summary of studies regarding radiographic assessment of cervical fusion * Authors & Year Class Description of Study Comments Tuli et al., 2004 III Prospective evaluation to determine the reliability of static radiographs in predicting fusion of 57 patients following cervical corpectomies & fusion w/ fibular allograft & anterior plate stabilization

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Karen Monuszko, Michael Malinzak, Lexie Zidanyue Yang, Donna Niedzwiecki, Herbert Fuchs, Carrie R. Muh, Krista Gingrich, Robert Lark, and Eric M. Thompson

V entriculoperitoneal shunts are the most common way to treat hydrocephalus, with approximately 39,000 shunt placement surgeries performed in the US each year. 1 Unfortunately, the rate of shunt failure within the first year after insertion approaches 40% and is greater than 50% by 2 years. 2 Thus, shunt continuity and position are frequently reassessed throughout a patient’s lifetime. The current standard of care accomplishes this using multiple conventional radiographs. A typical radiography “shunt series” consists of anterior-posterior (AP) and

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Karen Monuszko, Michael Malinzak, Lexie Zidanyue Yang, Donna Niedzwiecki, Herbert Fuchs, Carrie R. Muh, Krista Gingrich, Robert Lark, and Eric M. Thompson

V entriculoperitoneal shunts are the most common way to treat hydrocephalus, with approximately 39,000 shunt placement surgeries performed in the US each year. 1 Unfortunately, the rate of shunt failure within the first year after insertion approaches 40% and is greater than 50% by 2 years. 2 Thus, shunt continuity and position are frequently reassessed throughout a patient’s lifetime. The current standard of care accomplishes this using multiple conventional radiographs. A typical radiography “shunt series” consists of anterior-posterior (AP) and lateral

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Amos O. Dare, Mark S. Dias, and Veetai Li

), monoparesis, history of congenital abnormalities of the spine and/or spinal cord (for example, patients with spina bifida with Chiari malformations or tethered spinal cord) were excluded from the study. Twenty patients met the criteria for SCIWORA. All patients were initially evaluated with plain radiography of the spine, including static and dynamic (flexion—extension) studies. A CT scan of the spine was obtained in one patient, and a CT myelogram was acquired in a second patient, to investigate further the initial radiographic findings. All MR imaging studies were

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Matthias F. Oertel, Juliane Hobart, Marco Stein, Vanessa Schreiber, and Wolfram Scharbrodt

Navigation The O-arm system (Medtronic) used for this study allowed 2D and 3D radiographic imaging in the operating room, based on distortion-free digital flat-panel technology. The closed O-shaped gantry of the system was designed to guarantee sterility of the system during surgery and allows very fast 3D scans. A 3D image was acquired in 13 seconds, during which a total of 392 single images were recorded in a full 360° rotation of the radiation source and detector unit. The O-arm gantry was positioned from the lateral side over the patient before being closed. The

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J. Kenneth Burkus, Kevin Foley, Regis Haid, and Jean-Charles LeHuec

The authors present their radiographic criteria for assessing fusion of the lumbar spine after anterior interbody fusion with intradiscal implants. These criteria include the assessment of plain radiographs, dynamic motion radiographs, and thin-cut computerized tomography scans. Fusion within the instrumented spinal motion segment can be determined using radiographic evaluation to assess spinal alignment on sequential examinations, angular and translational changes on dynamic motion studies, and device–host interface, and to identify new bone formation and bone remodeling. Finally, to aid the clinician in assessing fusion, the authors describe the five zones of fusion within the intervertebral disc space.

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Daniel K. Resnick, Tanvir F. Choudhri, Andrew T. Dailey, Michael W. Groff, Larry Khoo, Paul G. Matz, Praveen Mummaneni, William C. Watters III, Jeffrey Wang, Beverly C. Walters, and Mark N. Hadley

Recommendations Standards Static lumbar radiographs are not recommended as a stand-alone means to assess fusion status following lumbar arthrodesis surgery. Guidelines 1) Lateral flexion and extension radiography is recommended as an adjunct to determine the presence of lumbar fusion postoperatively. The lack of motion between vertebrae, in the absence of rigid instrumentation, is highly suggestive of successful fusion. 2) Technetium-99 bone scanning is not recommended as a means to assess lumbar fusion. Options Several radiographic

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Daniel K. Resnick, Tanvir F. Choudhri, Andrew T. Dailey, Michael W. Groff, Larry Khoo, PauL G. Matz, Praveen Mummaneni, William C. Watters III, Jeffrey Wang, Beverly C. Walters, and Mark N. Hadley

Recommendations Standards There is insufficient evidence to recommend a treatment standard. Guidelines There is insufficient evidence to recommend a treatment guideline. Options It is recommended that when performing lumbar arthrodesis for degenerative lumbar disease, strategies to achieve successful radiographic fusion should be considered. There appears to be a correlation between successful fusion and improved clinical outcomes; however, it should be noted that the correlation between fusion status and clinical outcome is not strong

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Enrique Palacios and Edwin E. Macgee

palsies is a common accompaniment of infratentorial tumors. The spinal fluid protein is usually elevated. Radiographic Features The most constant finding on plain skull films is destruction of the anteromedial portion of the petrous apex, 7 which is typically smooth and well delineated ( Fig. 1 ). This destruction is pathognomonic of tumor extension into the posterior fossa. 4 Not infrequently the lesion extends anteriorly toward the foramen ovale or foramen rotundum. These changes can be best demonstrated with the use of tomography ( Fig. 2 ). Medial tumor

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Charles P. Bondurant and John J. Oró

threatening. 23 In addition, pediatric spinal cord injury more often demonstrates no radiographic abnormality. This further complicates diagnosis, treatment, and especially outcome since spinal cord injury without radiographic abnormality (SCIWORA) is more often complete. 16 Congenital cerebellar ectopia occurs rarely and is frequently grouped according to the extent of medullocerebellar displacement and associated anomalies. The eponymous Chiari I malformation describes the more benign case and includes those patients with displacement of non-neoplastic cerebellar