Radiologic assessment of interbody fusion using carbon fiber cages.
METHODS
A comparative study investigated the use of plain static radiographs, flexion-extension radiographs, and thin-section helical computed tomography (CT) scanning in the assessment of anterior lumbar interbody fusion using carbon fiber cages.


OBJECTIVE
To compare plain static radiographs, flexion-extension radiographs, and thin-section helical computed tomography scans in the assessment of lumbar interbody fusion using carbon fiber cages.


BACKGROUND
Lumbar interbody fusion has become a popular procedure for the treatment of discogenic back pain. However, there currently is no universally accepted radiologic assessment tool for determining fusion, and the definitive criteria for diagnosing a successful interbody fusion in the lumbar spine remains controversial.


METHODS
Plain static radiographs, flexion-extension radiographs, and helical computed tomography scans were performed on 32 patients (49 levels) 5 years after anterior lumbar interbody fusion using carbon fiber cages and autologous bone. A radiologist assessed fusion using the Hutter method to detect movement, whereas a spinal surgeon measured movement in degrees using the Simmons method. Helical computed tomography scans were assessed for the presence of bridging trabecular bone.


RESULTS
The fusion rate was 86% on plain radiographs and 84% with the Hutter method. The fusion rate was 74% with the 2 degrees cutoff, and 96% with the 5 degrees cutoff prescribed by the Food and Drug Administration. Fusion on helical computed tomography scans was observed in 65% of the patients.


CONCLUSIONS
In the radiologic assessment of interbody fusion using carbon fiber cages, the use of plain radiographs and flexion-extension radiographs produced much higher fusion rates than assessment with thin-section helical computed tomography scans. The thin-section helical computed tomography studies clearly demonstrated the radiographic presence or absence of bridging bone, a property that was not seen with plain static radiographs or flexion-extension radiographs.
Santos
Edward R G
ER
University of Adelaide and the Spinal Unit, Royal Adelaide Hospital, Adelaide, South Australia.
Goss
David G
DG
Morcom
Russel K
RK
Fraser
Robert D
RD
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D036542:Tomography, Spiral Computed