title: Radiographic assessment of cervical subaxial fusion.
abstract: OBJECTIVE
  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 >or= 2 mm is a more reliable indicator for pseudarthrosis than angular motion of 2 degrees 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.
authors.affiliation: Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Kaiser
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
authors.forename: Paul G
authors.initials: PG
authors.lastname: Matz
authors.forename: Paul A
authors.initials: PA
authors.lastname: Anderson
authors.forename: Michael W
authors.initials: MW
authors.lastname: Groff
authors.forename: Robert F
authors.initials: RF
authors.lastname: Heary
authors.forename: Langston T
authors.initials: LT
authors.lastname: Holly
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Ryken
authors.forename: Tanvir F
authors.initials: TF
authors.lastname: Choudhri
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Vresilovic
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Resnick
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D009038:Motion; D011542:Pseudarthrosis / Q000000981:diagnostic imaging* / Q000473:pathology; D011859:Radiography