Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: Radiographic assessment of fusion status

Update item information
Publication Type pre-print
School or College School of Medicine
Department Neurosurgery
Creator Dailey, Andrew T.
Other Author Choudhri, Tanvir F.; Mummaneni, Praveen V.; Dhall, SanJayS.; Eck, JasonC.; Groff, Michael W.; Ghogawala, Zoher; Watters III, William C.; Resnick, Daniel K.; Sharan, Alok; Wang, Jeffrey C.; Kaiser, Michael G.
Title Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: Radiographic assessment of fusion status
Date 2014-01-01
Description The ability to identify a successful arthrodesis is an essential element in the management of patients undergoing lumbar fusion procedures. The hypothetical gold standard of intraoperative exploration to identify, under direct observation, a solid arthrodesis is an impractical alternative. Therefore, radiographic assessment remains the most viable instrument to evaluate for a successful arthrodesis. Static radiographs, particularly in the presence of instrumentation, are not recommended. In the absence of spinal instrumentation, lack of motion on flexion-extension radiographs is highly suggestive of a successful fusion; however, motion observed at the treated levels does not necessarily predict pseudarthrosis. The degree of motion on dynamic views that would distinguish between a successful arthrodesis and pseudarthrosis has not been clearly defined. Computed tomography with fine-cut axial images and multiplanar views is recommended and appears to be the most sensitive for assessing fusion following instrumented posterolateral and anterior lumbar interbody fusions. For suspected symptomatic pseudarthrosis, a combination of techniques including static and dynamic radiographs as well as CT images is recommended as an option. Lack of facet fusion is considered to be more suggestive of a pseudarthrosis compared with absence of bridging posterolateral bone. Studies exploring additional noninvasive modalities of fusion assessment have demonstrated either poor potential, such as with 99mTc bone scans, or provide insufficient information to formulate a definitive recommendation.
Type Text
Publisher American Association of Neurological Surgeons
Volume 21
Issue 1
First Page 23
Last Page 30
Language eng
Bibliographic Citation Choudhri, T. F., Mummaneni, P. V., Dhall, S. S., Eck, J. C., Groff, M. W., Ghogawala, Z., Watters III, W. C., Dailey, A. T., Resnick, D. K., Sharan, A., Wang, J. C., & Kaiser, M.G. (2014). Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: Radiographic assessment of fusion status. Journal of Neurosurgery: Spine, 21(1), 23-30.
Rights Management (c) American Association of Neurological Surgeons
Format Medium application/pdf
Format Extent 1,252,597 bytes
Identifier uspace,18808
ARK ark:/87278/s60w1nvx
Setname ir_uspace
Date Created 2014-08-06
Date Modified 2014-08-07
ID 712626
Reference URL https://collections.lib.utah.edu/ark:/87278/s60w1nvx
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