Godlewski Bartosz, Bebenek Adam, Dominiak Maciej, Bochniak Marcin, Cieslik Piotr, Pawelczyk Tomasz
Department of Orthopaedics and Traumatology, with spinal Surgery Ward, Scanmed-St. Raphael Hospital, ul. Adama Bochenka 12, 04-141 Cracow, Poland.
Department of Orthopaedics and Traumatology, Military Institute of Medicine, 04-141 Warsaw, Poland.
J Clin Med. 2022 Oct 14;11(20):6066. doi: 10.3390/jcm11206066.
Most surgical procedures performed on account of degenerative disease of the cervical spine involve a discectomy and interbody fixation. Bone fusion at the implant placement site is evaluated post-operatively. It is agreed that computed tomography is the best modality for assessing bone union. We evaluated the results obtained with various methods based solely on conventional radiographs in the same group of patients and compared them with results obtained using a method that is a combination of CT and conventional radiography, which we considered the most precise and a reference method. We operated on a total of 170 disc spaces in a group of 104 patients. Fusion was evaluated at 12 months after surgery with five different and popular classifications based on conventional radiographs and then compared with the reference method. Statistical analyses of test accuracy produced the following classification of fusion assessment methods with regard to the degree of consistency with the reference method, in descending order: (1) bone bridging is visible on the anterior and/or posterior edge of the operated disc space on a lateral radiograph; (2) change in the value of Cobb's angle for a motion segment on flexion vs. extension radiographs (threshold for fusion vs. pseudoarthrosis is 2°); (3) change in the interspinous distance between process tips on flexion vs. extension radiographs (threshold of 2 mm); (4) change in the value of Cobb's angle of a motion segment (threshold of 4°); (5) change in the interspinous distance between process bases on flexion vs. extension radiographs (threshold of 2 mm). When bone union is evaluated on the basis on radiographs, without CT evidence, we suggest using the "bone bridging" criterion as the most reliable commonly used approach to assessing bone union.
大多数因颈椎退行性疾病而进行的外科手术都包括椎间盘切除术和椎间融合内固定术。术后需评估植入部位的骨融合情况。目前公认计算机断层扫描是评估骨愈合的最佳方式。我们仅基于传统X线片，评估了同一组患者采用各种方法所获得的结果，并将其与采用CT和传统X线摄影相结合的方法所获得的结果进行比较，我们认为后者是最精确的参考方法。我们对104例患者的总共170个椎间盘间隙进行了手术。术后12个月，采用基于传统X线片的五种不同且常用的分级方法评估融合情况，然后与参考方法进行比较。对检测准确性的统计分析得出了以下关于融合评估方法与参考方法一致性程度的分级，从高到低依次为：（1）在侧位X线片上，手术椎间盘间隙的前缘和/或后缘可见骨桥形成；（2）屈伸位X线片上运动节段的Cobb角值变化（融合与假关节形成的阈值为2°）；（3）屈伸位X线片上棘突尖端间棘间距离的变化（阈值为2mm）；（4）运动节段Cobb角值的变化（阈值为4°）；（5）屈伸位X线片上棘突根部间棘间距离的变化（阈值为2mm）。当基于X线片评估骨愈合情况而无CT证据时，我们建议使用“骨桥形成”标准作为评估骨愈合最可靠的常用方法。
