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Reliability of Clinical Measurement for Assessing Spinal Fusion: An Experimental Sheep Study.
MedLine Citation:
PMID:  21897345     Owner:  NLM     Status:  Publisher    
ABSTRACT: Study Design. A sheep study designed to compare the accuracy of static radiographs, dynamic radiographs and computed tomography (CT) for the assessment of thoracolumbar facet joint fusion as determined by micro CT scanning.Objective. To determine the accuracy and reliability of conventional imaging techniques in identifying the status of thoracolumbar (T13-L1) facet joint fusion in a sheep model.Summary of Background Data. Plain radiographs are commonly employed to determine the integrity of surgical arthrodesis of the thoracolumbar spine. Many previous studies of fusion success have relied solely on postoperative assessment of plain radiographs, a technique lacking sensitivity for pseudarthrosis. Computerised tomography may be a more reliable technique but is less well characterised.Methods. Eleven adult sheep were randomised to either attempted arthrodesis using autogenous bone graft and internal fixation (n = 3) or interposition pseudarthrosis (IP) using oxidised cellulose and internal fixation (n = 8). After 6 months facet joint fusion was assessed by independent observers using (1) plain static radiography alone (2) additional dynamic radiographs and (3) additional reconstructed spiral CT imaging. These assessments were correlated with high resolution micro-CT imaging in order to predict the utility of the conventional imaging techniques in the estimation of fusion success.Results. The capacity of plain radiography alone to correctly predict fusion or pseudarthrosis was 43%, and was not improved using plain radiography and dynamic radiography with also a 43% accuracy. Adding assessment by reformatted CT imaging to the plain radiography techniques increased the capacity to correctly predict fusion outcome to 86%. The sensitivity, specificity and accuracy of static radiography were 0.33, 0.55 and 0.43. Those of dynamic radiography were 0.46, 0.40 and 0.43. Those of radiography plus CT scan were 0.88, 0.85 and 0.86.Conclusion. CT-based evaluation correlated most closely with high resolution micro-CT imaging Neither plain static nor dynamic radiographs were able to predict fusion outcome accurately.
Sadahiro Sugiyama; Martin Wullschleger; Kathleen Wilson; Richard Williams; Ben Goss
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-2
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
*Queensland University of Technology Institute of Health and Biomedical Innovation **The Prince Charles Hospital Cardiovascular Research Operating Theatre ***Princess Alexandra Hospital AO spine reference centre.
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