Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
Skeletal Radiol. 2019 Oct;48(10):1499-1510. doi: 10.1007/s00256-019-03181-5. Epub 2019 Feb 23.
The aim of the study was to determine the diagnostic accuracy of imaging modalities to detect pseudarthrosis after thoracolumbar spinal fusion, with surgical exploration as reference standard.
A systematic literature search for original studies was performed on the diagnostic accuracy of imaging as index test compared to surgical exploration as reference standard to diagnose pseudarthrosis after thoracolumbar spinal fusion. Diagnostic accuracy values were extracted and methodologic quality of studies was evaluated by the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Per modality, clinically comparable studies were included in subgroup meta-analysis and weighted odds ratios (ORs) were calculated using the random effects model.
Fifteen studies were included. Risk of bias was classified as high/unclear in 58% of the studies. Concerns of applicability was classified as high/unclear in 40% of the studies. Four scintigraphy studies including 93 patients in total were pooled to OR = 2.91 (95% confidence interval [CI]: 0.93-9.13). Five studies on plain radiography with 398 patients in total were pooled into OR = 7.07 (95% CI: 2.97-16.86). Two studies evaluating flexion-extension radiography of 75 patients in total were pooled into OR = 4.00 (95% CI: 0.15-105.96). Two studies of 68 patients in total were pooled for CT and yielded OR = 17.02 (95% CI: 6.42-45.10). A single study reporting on polytomography, OR = 10.15 (95% CI 5.49-18.78), was also considered to be an accurate study.
With a pooled OR of 17.02, CT can be considered the most accurate imaging modality for the detection of pseudarthrosis after thoracolumbar spinal fusion from this review.
本研究旨在确定影像学在检测胸腰椎脊柱融合术后假关节中的诊断准确性，以手术探查作为参考标准。
系统检索了以手术探查为参考标准，评估影像学诊断胸腰椎脊柱融合术后假关节的原始研究文献。提取诊断准确性值，并使用 QUADAS-2 工具评估研究的方法学质量。按检查方法进行亚组汇总分析，纳入具有可比性的临床研究，使用随机效应模型计算加权比值比（OR）。
共纳入 15 项研究。58%的研究存在高/不确定偏倚风险，40%的研究存在高/不确定适用性问题。4 项核素扫描研究共纳入 93 例患者，汇总 OR=2.91（95%可信区间：0.93-9.13）。5 项 X 线平片研究共纳入 398 例患者，汇总 OR=7.07（95%可信区间：2.97-16.86）。2 项评价脊柱屈伸位 X 线的研究共纳入 75 例患者，汇总 OR=4.00（95%可信区间：0.15-105.96）。2 项 CT 研究共纳入 68 例患者，汇总 OR=17.02（95%可信区间：6.42-45.10）。1 项报道多层面 CT 的研究，OR=10.15（95%可信区间 5.49-18.78），也被认为是一项准确的研究。
本研究汇总 OR 为 17.02，提示 CT 可能是诊断胸腰椎脊柱融合术后假关节最准确的影像学方法。
