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Comparison of plain radiographs with CT scan to evaluate interbody fusion following the use of titanium interbody cages and transpedicular instrumentation

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Abstract

The availability of lumbar interbody cages has fuelled renewed interest in interbody fusion. Despite this, there is no consensus regarding the best non-invasive method for evaluation of interbody fusion, especially where cages have been used. The purpose of this study was to determine whether high-quality thin-slice (1- to 3-mm) computed tomography (CT) scans allow proper evaluation of interbody fusion through titanium cages. Patients undergoing lumbar interbody fusion were prospectively evaluated with CT scan and plain radiographs 6 months following surgery. These images were blindly and independently evaluated by a consultant radiologist and a spine research fellow, for bridging bony trabeculation both through and surrounding the cages as well as for changes at the cage endplate interface. Fifty-three patients (156 cages) undergoing posterior lumbar interbody fusion using titanium interbody cages were evaluated. Posterior elements were used to pack the cages and no graft was packed outside the cages. The outcome data were analysed using the Kappa co-efficient and chi-squared analysis. On CT scan, both observers noted bridging trabeculation in 95% of the cages (Kappa 0.85), while on radiographs this was present in only 4% (Kappa 0.74). Both observers also identified bridging trabeculation surrounding the cages on CT scan in 90% of cages (Kappa 0.82), while on the radiographs this was 8% (Kappa 0.86). Radiographs also failed to demonstrate all the loose cages. The results of the study show that high-quality CT scans show images suggesting bridging bony trabeculae following the use of titanium interbody cages. They also appear to show consistent bone outside the cages in spite of no bone graft having been used, and they appear to be better than plain radiographs in the early detection of cage loosening.

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Acknowledgement

The authors acknowledge the statistical advice given by Dr. Richard Morris, Department of Primary Care and Population Sciences, Royal Free & University College Medical School, London, UK.

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Author notes

  1. Rajesh R. Shah

    Present address: c/o B. A. Taylor, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK

Authors and Affiliations

  1. Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK

    Rajesh R. Shah, Asif Saifuddin & Benjamin A. Taylor

  2. Hope Hospital, Salford, Manchester, UK

    Saeed Mohammed

Authors
  1. Rajesh R. Shah
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  2. Saeed Mohammed
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  3. Asif Saifuddin
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  4. Benjamin A. Taylor
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Corresponding author

Correspondence to Rajesh R. Shah.

Additional information

The work for this study was carried out at the Spinal Surgical Unit of the Royal National Orthopaedic Hospital. No financial support of any kind has been received from any party for the purpose of this study

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Shah, R.R., Mohammed, S., Saifuddin, A. et al. Comparison of plain radiographs with CT scan to evaluate interbody fusion following the use of titanium interbody cages and transpedicular instrumentation. Eur Spine J 12, 378–385 (2003). https://doi.org/10.1007/s00586-002-0517-4

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  • DOI: https://doi.org/10.1007/s00586-002-0517-4

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