Rhee John M, Chapman Jens R, Norvell Daniel C, Smith Justin, Sherry Ned A, Riew K Daniel
*Department of Orthopaedic Surgery, Emory Spine Center, Emory University, Atlanta, GA †Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA ‡Spectrum Research, Inc., Tacoma, WA §University of Virginia, Charlottesville, VA; and ¶Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO.
Spine (Phila Pa 1976). 2015 Jul 1;40(13):974-91. doi: 10.1097/BRS.0000000000000940.
Systematic review.
To determine best criteria for radiological determination of postoperative subaxial cervical fusion to be applied to current clinical practice and ongoing future research assessing fusion to standardize assessment and improve comparability.
Despite availability of multiple imaging modalities and criteria, there remains no method of determining cervical fusion with absolute certainty, nor clear consensus on specific criteria to be applied.
A systematic search in MEDLINE/Cochrane Collaboration Library (through March 2014). Included studies assessed C2 to C7 via anterior or posterior approach, at 12 weeks or more postoperative, with any graft or implant. Overall body of evidence with respect to 6 posited key questions was determined using Grading of Recommendations Assessment, Development and Evaluation and Agency for Healthcare Research and Quality precepts.
Of plain radiographical modalities, there is moderate evidence that the interspinous process motion method (<1 mm) is more accurate than the Cobb angle method for assessing anterior cervical fusion. Of the advanced imaging modalities, there is moderate evidence that computed tomography (CT) is more accurate and reliable than magnetic resonance imaging in assessing anterior cervical fusion. There is insufficient evidence regarding the optimal modality and criteria for assessing posterior cervical fusions and insufficient evidence to support a single time point after surgery as being optimal for determining fusion, although some evidence suggest that reliability of radiography and CT improves with increasing time postoperatively.
We recommend using less than 1-mm motion as the initial modality for determining anterior cervical arthrodesis for both clinical and research applications. If further imaging is needed because of indeterminate radiographical evaluation, we recommend CT, which has relatively high accuracy and reliability, but due to greater radiation exposure and cost, it is not routinely suggested. We recommend that plain radiographs also be the initial method of determining posterior cervical fusion but suggest a lower threshold for obtaining CT scans because dynamic radiographs may not be as useful if spinous processes have been removed by laminectomy.
系统评价。
确定用于术后下颈椎融合影像学判定的最佳标准，以应用于当前临床实践及未来评估融合情况的研究，从而规范评估并提高可比性。
尽管有多种成像方式和标准可用，但仍没有绝对确定的方法来判定颈椎融合，对于应用的具体标准也未达成明确共识。
在MEDLINE/考克兰协作图书馆进行系统检索（截至2014年3月）。纳入的研究通过前路或后路手术，在术后12周或更长时间，对使用任何移植物或植入物的C2至C7节段进行评估。使用推荐分级评估、制定与评价以及医疗保健研究与质量机构的原则，确定关于6个假定关键问题的总体证据。
在普通X线成像方式中，有中等证据表明，棘突间活动度法（<1mm）在评估颈椎前路融合时比Cobb角法更准确。在先进成像方式中，有中等证据表明，计算机断层扫描（CT）在评估颈椎前路融合时比磁共振成像更准确、可靠。关于评估颈椎后路融合的最佳方式和标准，证据不足；对于确定融合的最佳术后单一时间点，也缺乏足够证据支持，不过一些证据表明，X线摄影和CT的可靠性会随着术后时间的延长而提高。
我们建议，对于临床和研究应用，均采用小于1mm的活动度作为判定颈椎前路融合的初始方式。如果因X线评估不确定而需要进一步成像，我们推荐CT，其具有相对较高的准确性和可靠性，但由于辐射暴露和成本较高，不建议常规使用。我们建议X线平片也作为判定颈椎后路融合的初始方法，但鉴于如果已行椎板切除术切除棘突，动态X线片可能不太有用，因此建议获取CT扫描的阈值较低。
1级。
