Wang Haoxiang, Xia Tian, Qu Ruomu, Sun Yu, Zhang Fengshan, Pan Shengfa, Chen Xin, Zhao Yanbin, Jiang Liang, Zhou Feifei
Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
Spine (Phila Pa 1976). 2025 Feb 1;50(3):E39-E45. doi: 10.1097/BRS.0000000000005101. Epub 2024 Jul 23.
A retrospective diagnostic test study.
To establish quantitative fusion criteria for ACCF.
Currently, the criteria of fusion after ACCF remains controversial. Evaluation techniques such as observation of continuous bony trabeculae across the fusion site were qualitative and conducted by naked eyes, limiting its accuracy. Dynamic fusion indicators such as interspinous motion (ISM) have been successfully utilized in anterior cervical discectomy and fusion (ACDF) for evaluating fusion and detecting pseudarthrosis. However, the accuracy of ISM in ACCF is unclear.
Patients who underwent ACCF in our hospital were reviewed. Imaging data including dynamic radiographs and computed tomography (CT) scans were collected. The distance and angle form of ISM (ISM-dis and ISM-ang) were measured on dynamic radiograph, with CT as the gold standard for fusion. The correlation between ISM methods was analyzed using Spearmann correlation. Receiver operating characteristic (ROC) curves were used to evaluate the accuracy and generate optimal cutoff values. Three observers independently measured the data twice to determine interobserver and intraobserver reliability.
Our study included 178 imaging datasets. ISM-dis showed positive correlation with ISM-ang (r=0.914). The area under ROC (AUC) for ISM-dis and ISM-ang was 0.926 and 0.893. Applying a cutoff value of 1.50 mm to ISM-dis yielded a sensitivity of 87.8% and specificity of 92.3% for detecting pseudarthrosis. For ISM-ang, a cutoff value of 1.75° resulted in a sensitivity of 79.1% and specificity of 92.3%. Intraobserver reliabilities for ISM-dis (0.986, 0.984, and 0.972) were higher than for ISM-ang (0.935, 0.963, and 0.935), as was interobserver reliability (0.985 for ISM-dis and 0.956 for ISM-ang). Fusion rates calculated using ISM-dis and ISM-ang were 52.4% and 61.9%.
ISM can serve as an alternative to CT for assessing fusion, with ISM-dis at a 1.50-mm cutoff and ISM-ang at 1.75°, demonstrating high diagnostic accuracy.
一项回顾性诊断试验研究。
建立ACCF的定量融合标准。
目前，ACCF术后的融合标准仍存在争议。诸如观察融合部位连续骨小梁等评估技术是定性的，且通过肉眼进行，限制了其准确性。动态融合指标如棘突间运动（ISM）已成功应用于颈椎前路椎间盘切除融合术（ACDF）中以评估融合情况及检测假关节形成。然而，ISM在ACCF中的准确性尚不清楚。
回顾我院接受ACCF的患者。收集包括动态X线片和计算机断层扫描（CT）扫描在内的影像数据。在动态X线片上测量ISM的距离和角度形式（ISM-dis和ISM-ang），以CT作为融合的金标准。使用Spearman相关性分析ISM方法之间的相关性。采用受试者工作特征（ROC）曲线评估准确性并生成最佳截断值。三名观察者独立对数据进行两次测量以确定观察者间和观察者内的可靠性。
我们的研究纳入了178个影像数据集。ISM-dis与ISM-ang呈正相关（r = 0.914）。ISM-dis和ISM-ang的ROC曲线下面积（AUC）分别为0.926和0.893。将ISM-dis的截断值设为1.50 mm时，检测假关节形成的灵敏度为87.8%，特异度为92.3%。对于ISM-ang，截断值为1.75°时，灵敏度为79.1%，特异度为92.3%。ISM-dis的观察者内可靠性（0.986、0.984和0.972）高于ISM-ang（0.935、0.963和0.935），观察者间可靠性也是如此（ISM-dis为0.985，ISM-ang为0.956）。使用ISM-dis和ISM-ang计算的融合率分别为52.4%和61.9%。
ISM可作为评估融合情况替代CT的方法，ISM-dis的截断值为1.50 mm，ISM-ang的截断值为1.75°，显示出较高的诊断准确性。
