腰椎椎间融合评价方法的影像学及临床分析-imaging and clinical analysis of lumbar intervertebral fusion evaluation method.docxVIP

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腰椎椎间融合评价方法的影像学及临床分析-imaging and clinical analysis of lumbar intervertebral fusion evaluation method.docx

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腰椎椎间融合评价方法的影像学及临床分析-imaging and clinical analysis of lumbar intervertebral fusion evaluation method

AbstractObjective: Pseudoarthrosis is one of the most significant causes of recurrent symptoms after lumbar interbody fusion. However, there are currently no definitive criteria for diagnosing a successful interbody. We believe that evaluating fusion status using computed tomography (CT) in flexion position to detect pseudoarthrosis more precisely. The purpose of this study was to evaluate its usefulness for determining fusion status after PLIF.Methods: forty-eight patients who underwent PLIF at 58 levels were retrospectively enrolled. Patients were followed up for more than 12 months after surgery. The mean follow-up period was 14.6 months (range 13–18months). Fusion status was evaluated using five ways: static radiographs，dynamic radiographs，CT in neutral position，CT in extension position and CT in flexion positon. All patients underwent a spinal fusion radiologic assessment using static radiographs and flexion–extension radiographs every 3 months postoperatively. CT was performed at 6 and 12 months postoperatively.Results: Flexion CT demonstrated a solid fusion in 66% of the 58 levels at 12 months postoperatively. When the fusion was demonstrated on extension CT, the rate of fusion affirmed by static radiographs, flexion–extension radiographs ，neutral CT and extensionCT was 90%, 88% ,78% and 81% of the levels assessed, respectively. Statistical analysisshowed that the rate of fusion evaluated by flexion CT was significantly lower than by the other four evaluation method with statistically significant.The rate of pseudoarthrosisdetected on flexion CT images was significantly higher than that on neutral CT(P＜0.01),extension CT(P＜0.01), flexion–extension radiographs(P＜0.001) and static radiographs(P＜0.001).Conclusion: Flexion CT could detect pseudoarthrosis more clearly than static radiographs ，flexion–extension radiography, neutral CT and extension CT. The CT images are influenced by body position and dilating posterior disc space in flexion CT contributest