Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: radiographic assessment of fusion

Standards. Static lumbar radiographs are not recommended as a stand-alone means to assess fusion status following lumbar arthrodesis surgery. Guidelines. 1) Lateral flexion and extension radiography is recommended as an adjunct to determine the presence of lumbar fusion postoperatively. The lack of motion between vertebrae, in the absence of rigid instrumentation, is highly suggestive of successful fusion. 2) Technetium-99 bone scanning is not recommended as a means to assess lumbar fusion. Options. Several radiographic techniques, including static radiography, lateral flexion-extension radiography, and/ or CT scanning, often in combination, are recommended as assessment modality options for the noninvasive evaluation of symptomatic patients in whom failed lumbar fusion is suspected.