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An evaluation of fusion status following lumbar fusion surgery utilizing multi-planar computed tomography

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Abstract

Purpose

To report the rate of fusion in a sample of patients undergoing lumbar fusion surgery and assess interrater reliability of computed tomography (CT)-based parameters for the assessment of fusion.

Methods

All adult patients who underwent lumbar fusion surgery from 2017 to 2021 were retrospectively identified. Patient demographics and surgical characteristics were collected through chart review of the electronic medical records. CT scans were reviewed independently by two attending spine surgeons and two spine fellows. Fusion was defined as evidence of bone bridging in any one of (1) posterolateral gutters, (2) facets, or (3) interbody (when applicable) on any CT views. Evidence of screw haloing was indicative of nonunion. Interrater reliability was determined using cohen’s kappa. Afterwards, a consensus agreement for each component of fusion was reached between participants.

Results

The overall fusion rate among all procedures was 63/69 (91.3%). Overall 22/25 (88.0%) TLIF, 16/19 (84.2%) PLDF, 3/3 (100%) LLIF, and 22/22 (100%) circumferential fusions experienced a successful fusion. Interrater reliability was good for interbody fusion (k = 0.734) and moderate for all other measures (k = 0.561 for posterolateral fusion; k = 0.471 for facet fusion; k = 0.458 for screw haloing). Overall, interrater reliability as to whether a patient had a fusion or nonunion was moderate (k = 0.510).

Conclusion

There was only moderate interrater reliability across most radiographic measures used in assessing lumbar fusion status. Reliability was highest when evaluating the presence of interbody fusion. The majority of fusions occurred across the facet joints.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Tariq Z. Issa, Yunsoo Lee, Jeremy Heard, Tyler W. Henry, Michael A. McCurdy, Caroline Zaworksi, Julia Dambly, Jose A. Canseco, Alan S. Hilibrand, Alexander R. Vaccaro, Gregory D. Schroeder, John Mangan & Christopher K. Kepler

  2. Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA

    Tariq Z. Issa

  3. Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA

    Nicholas Siegel

  4. Department of Orthopaedic Surgery, Washington University Hospital, St. Louis, MO, USA

    Mark Lambrechts

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  1. Tariq Z. Issa
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  2. Yunsoo Lee
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Correspondence to Tariq Z. Issa.

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Issa, T.Z., Lee, Y., Heard, J. et al. An evaluation of fusion status following lumbar fusion surgery utilizing multi-planar computed tomography. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08408-1

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