Radiographic assessment of cervical subaxial fusion

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  • 1 Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York;
  • | 2 Department of Neurosurgery, University of California at San Francisco, California;
  • | 3 Division of Neurological Surgery, University of Alabama, Birmingham, Alabama;
  • | 4 Departments of Orthopaedic Surgery and
  • | 11 Neurological Surgery, University of Wisconsin, Madison, Wisconsin;
  • | 5 Department of Neurosurgery, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts;
  • | 6 Department of Neurosurgery, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, New Jersey;
  • | 7 Division of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, California;
  • | 8 Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa;
  • | 9 Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York; and
  • | 10 Department of Orthopaedic Surgery, Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, Hershey, Pennsylvania
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Object

The objective of this systematic review was to use evidence-based medicine to identify the best methodology for radiographic assessment of cervical subaxial fusion.

Methods

The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical fusion. Abstracts were reviewed and studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.

Results

Pseudarthrosis is best assessed through the absence of motion detected between the spinous processes on dynamic radiographs (Class II). The measurement of interspinous distance on dynamic radiographs of ≥ 2 mm is a more reliable indicator for pseudarthrosis than angular motion of 2° based on Cobb angle measurements (Class II). Similarly, it is also understood that the pseudarthrosis rate will increase as the threshold for allowable motion on dynamic radiographs decreases. The combination of interspinous distance measurements and identification of bone trabeculation is unreliable when performed by the treating surgeon (Class II). Identification of bone trabeculation on static radiographs should be considered a less reliable indicator of cervical arthrodesis than dynamic films (Class III).

Conclusions

Consideration should be given to dynamic radiographs and interspinous distance when assessing for pseudarthrosis.

Abbreviations used in this paper:

ROC = receiver operating characteristic; RS = roentgen stereophotogrammetry; VB = vertebral body.

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Contributor Notes

Address correspondence to: Paul G. Matz, M.D., Neurosurgery and Neurology, LLC, 232 South Woods Mill Road, Chesterfield, Missouri 63017. email: matzpg@yahoo.com.
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