Radiographic assessment of cervical subaxial fusion

Michael G. Kaiser, Praveen V. Mummaneni, Paul G. Matz, Paul A. Anderson, Michael W. Groff, Robert F. Heary, Langston T. Holly, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. Vresilovic, Daniel K. Resnick

Research output: Contribution to journalReview article

37 Citations (Scopus)

Abstract

Object. The objective of this systematic review was to use evidence-based medicine to identify the best methodology for radiographic assessment of cervical subaxial fusion. Methods. The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical fusion. Abstracts were reviewed and studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results. Pseudarthrosis is best assessed through the absence of motion detected between the spinous processes on dynamic radiographs (Class II). The measurement of interspinous distance on dynamic radiographs of ≥ 2 mm is a more reliable indicator for pseudarthrosis than angular motion of 2° based on Cobb angle measurements (Class II). Similarly, it is also understood that the pseudarthrosis rate will increase as the threshold for allowable motion on dynamic radiographs decreases. The combination of interspinous distance measurements and identification of bone trabeculation is unreliable when performed by the treating surgeon (Class II). Identification of bone trabeculation on static radiographs should be considered a less reliable indicator of cervical arthrodesis than dynamic films (Class III). Conclusions. Consideration should be given to dynamic radiographs and interspinous distance when assessing for pseudarthrosis.

Original languageEnglish (US)
Pages (from-to)221-227
Number of pages7
JournalJournal of Neurosurgery: Spine
Volume11
Issue number2
DOIs
StatePublished - Aug 1 2009

Fingerprint

Pseudarthrosis
Guidelines
Angle Class II Malocclusion
Medical Subject Headings
National Library of Medicine (U.S.)
Bone and Bones
Peer Review
Arthrodesis
Evidence-Based Medicine
Consensus
Joints
Databases

All Science Journal Classification (ASJC) codes

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

Kaiser, M. G., Mummaneni, P. V., Matz, P. G., Anderson, P. A., Groff, M. W., Heary, R. F., ... Resnick, D. K. (2009). Radiographic assessment of cervical subaxial fusion. Journal of Neurosurgery: Spine, 11(2), 221-227. https://doi.org/10.3171/2009.3.SPINE08719
Kaiser, Michael G. ; Mummaneni, Praveen V. ; Matz, Paul G. ; Anderson, Paul A. ; Groff, Michael W. ; Heary, Robert F. ; Holly, Langston T. ; Ryken, Timothy C. ; Choudhri, Tanvir F. ; Vresilovic, Edward J. ; Resnick, Daniel K. / Radiographic assessment of cervical subaxial fusion. In: Journal of Neurosurgery: Spine. 2009 ; Vol. 11, No. 2. pp. 221-227.
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abstract = "Object. The objective of this systematic review was to use evidence-based medicine to identify the best methodology for radiographic assessment of cervical subaxial fusion. Methods. The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical fusion. Abstracts were reviewed and studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results. Pseudarthrosis is best assessed through the absence of motion detected between the spinous processes on dynamic radiographs (Class II). The measurement of interspinous distance on dynamic radiographs of ≥ 2 mm is a more reliable indicator for pseudarthrosis than angular motion of 2° based on Cobb angle measurements (Class II). Similarly, it is also understood that the pseudarthrosis rate will increase as the threshold for allowable motion on dynamic radiographs decreases. The combination of interspinous distance measurements and identification of bone trabeculation is unreliable when performed by the treating surgeon (Class II). Identification of bone trabeculation on static radiographs should be considered a less reliable indicator of cervical arthrodesis than dynamic films (Class III). Conclusions. Consideration should be given to dynamic radiographs and interspinous distance when assessing for pseudarthrosis.",
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Kaiser, MG, Mummaneni, PV, Matz, PG, Anderson, PA, Groff, MW, Heary, RF, Holly, LT, Ryken, TC, Choudhri, TF, Vresilovic, EJ & Resnick, DK 2009, 'Radiographic assessment of cervical subaxial fusion', Journal of Neurosurgery: Spine, vol. 11, no. 2, pp. 221-227. https://doi.org/10.3171/2009.3.SPINE08719

Radiographic assessment of cervical subaxial fusion. / Kaiser, Michael G.; Mummaneni, Praveen V.; Matz, Paul G.; Anderson, Paul A.; Groff, Michael W.; Heary, Robert F.; Holly, Langston T.; Ryken, Timothy C.; Choudhri, Tanvir F.; Vresilovic, Edward J.; Resnick, Daniel K.

In: Journal of Neurosurgery: Spine, Vol. 11, No. 2, 01.08.2009, p. 221-227.

Research output: Contribution to journalReview article

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T1 - Radiographic assessment of cervical subaxial fusion

AU - Kaiser, Michael G.

AU - Mummaneni, Praveen V.

AU - Matz, Paul G.

AU - Anderson, Paul A.

AU - Groff, Michael W.

AU - Heary, Robert F.

AU - Holly, Langston T.

AU - Ryken, Timothy C.

AU - Choudhri, Tanvir F.

AU - Vresilovic, Edward J.

AU - Resnick, Daniel K.

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N2 - Object. The objective of this systematic review was to use evidence-based medicine to identify the best methodology for radiographic assessment of cervical subaxial fusion. Methods. The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical fusion. Abstracts were reviewed and studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results. Pseudarthrosis is best assessed through the absence of motion detected between the spinous processes on dynamic radiographs (Class II). The measurement of interspinous distance on dynamic radiographs of ≥ 2 mm is a more reliable indicator for pseudarthrosis than angular motion of 2° based on Cobb angle measurements (Class II). Similarly, it is also understood that the pseudarthrosis rate will increase as the threshold for allowable motion on dynamic radiographs decreases. The combination of interspinous distance measurements and identification of bone trabeculation is unreliable when performed by the treating surgeon (Class II). Identification of bone trabeculation on static radiographs should be considered a less reliable indicator of cervical arthrodesis than dynamic films (Class III). Conclusions. Consideration should be given to dynamic radiographs and interspinous distance when assessing for pseudarthrosis.

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Kaiser MG, Mummaneni PV, Matz PG, Anderson PA, Groff MW, Heary RF et al. Radiographic assessment of cervical subaxial fusion. Journal of Neurosurgery: Spine. 2009 Aug 1;11(2):221-227. https://doi.org/10.3171/2009.3.SPINE08719