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Type: Journal article
Title: Radiologic assessment of spinal fusion
Author: Selby, M.
Clark, S.
Hall, D.
Freeman, B.
Citation: American Academy of Orthopaedic Surgeons. Journal, 2012; 20(11):694-703
Publisher: American Academy of Orthopaedic Surgeons
Issue Date: 2012
ISSN: 1067-151X
Statement of
Michael Derrick Selby, Simon Richard Clark, David John Hall and Brian J.C. Freeman
Abstract: Since surgical fusion of the spine was first described in 1911, multiple methods have been used to assess it. Although open surgical exploration remains the standard of care for determination of fusion, it is impractical in most clinical situations. Static radiographs have long been used as a practical method of fusion assessment, but they tend to significantly overestimate the presence of a solid fusion. Dynamic radiographs improve accuracy but limitations include measurement reliability, disagreement on allowable motion, and the two-dimensional nature of radiographs. Ultimately, lack of movement at a fused segment does not confirm fusion. Radiostereometric analysis further improves accuracy; however, methodological demands make it largely impractical for routine use. CT is now widely accepted as the standard for noninvasive assessment of spinal fusion. Fine-cut imaging, multiplanar reconstruction, and metal artifact reduction have increased the ability to assess fusion on CT. However, significant concerns remain regarding the effects of high radiation exposure. Although MRI is appealing, its utility in assessing fusion remains unproven. Understanding the limitations of each technique allows judicious use of radiology in the assessment of spinal fusion.
Keywords: Spine; Cervical Vertebrae; Humans; Osteolysis; Pseudarthrosis; Bone Substitutes; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Spinal Fusion; Diskectomy; Radiostereometric Analysis
Rights: © 2012 by the American Academy of Orthopaedic Surgeons
RMID: 0020126364
DOI: 10.5435/JAAOS-20-11-694
Appears in Collections:Orthopaedics and Trauma publications

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