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Issa TZ, Lee Y, Heard J, Henry TW, McCurdy MA, Siegel N, Zaworksi C, Dambly J, Canseco JA, Hilibrand AS, Vaccaro AR, Schroeder GD, Mangan J, Lambrechts M, Kepler CK. An evaluation of fusion status following lumbar fusion surgery utilizing multi-planar computed tomography. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08408-1. [PMID: 39095491 DOI: 10.1007/s00586-024-08408-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/11/2024] [Accepted: 07/09/2024] [Indexed: 08/04/2024]
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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Affiliation(s)
- Tariq Z Issa
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA.
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA.
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jeremy Heard
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Tyler W Henry
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Michael A McCurdy
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nicholas Siegel
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Caroline Zaworksi
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Julia Dambly
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - John Mangan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mark Lambrechts
- Department of Orthopaedic Surgery, Washington University Hospital, St. Louis, MO, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Yeo J. Failed back surgery syndrome-terminology, etiology, prevention, evaluation, and management: a narrative review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2024; 41:166-178. [PMID: 38853538 PMCID: PMC11294787 DOI: 10.12701/jyms.2024.00339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 06/11/2024]
Abstract
Amid the worldwide increase in spinal surgery rates, a significant proportion of patients continue to experience refractory chronic pain, resulting in reduced quality of life and escalated healthcare demands. Failed back surgery syndrome (FBSS) is a clinical condition characterized by persistent or recurrent pain after one or more spinal surgeries. The diverse characteristics and stigmatizing descriptions of FBSS necessitate a reevaluation of its nomenclature to reflect its complexity more accurately. Accurate identification of the cause of FBSS is hampered by the complex nature of the syndrome and limitations of current diagnostic labels. Management requires a multidisciplinary approach that may include pharmacological treatment, physical therapy, psychological support, and interventional procedures, emphasizing realistic goal-setting and patient education. Further research is needed to increase our understanding, improve diagnostic accuracy, and develop more effective management strategies.
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Affiliation(s)
- Jinseok Yeo
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
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Hasan S, Al-Jamal M, Miller A, Higginbotham DO, Cavazos DR, Waheed M, Saleh E, McCarty SA. Efficacy and Outcome Measurement of iFactor/ABM/P-15 in Lumbar Spine Surgery: A Systematic Review. Global Spine J 2024; 14:1422-1433. [PMID: 37994908 PMCID: PMC11289567 DOI: 10.1177/21925682231217253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To determine the efficacy and overall outcomes of iFactor/ABM/P-15 following lumbar spine surgery. METHODS We performed a search of the Cochrane Library, Medline Ovid, PubMed, and SCOPUS databases from inception until August 2023. Eligible studies included outcomes of patients receiving iFactor following lumbar spine surgery. The primary outcomes of interest were fusion rates and iFactor efficacy after lumbar surgery in patients who received iFactor. Secondary outcomes included patient-reported outcomes and complication rates. RESULTS A total of 766 titles were initially screened. After inclusion criteria were applied, 5 studies (388 patients) were included, which measured overall outcomes of iFactor/ABM/P-15 following lumbar spine surgery. These studies showed acceptable reliability for inclusion based on the Methodical Index for Non-Randomized studies and Critical Appraisal Skills Programme assessment tools. iFactor/ABM/P-15 facilitated significantly faster bone development in various procedures while maintaining favorable clinical outcomes compared to traditional grafts. CONCLUSIONS This systematic review found that iFactor/ABM/P-15 use for lumbar spine surgery maintains similar managing patient-reported outcomes relative to other grafting methods. In regard to rates of fusion, iFactor/ABM/P-15 showed a significantly faster rate of fusion when compared to traditional grafts including allograft, autograft, demineralized bone matrix (DBM), and recombinant human bone morphogenetic protein-2 (rhBMP-2). Future multicenter randomized control trials with larger sample sizes are recommended to further assess iFactor/ABM/P-15 efficacy in lumbar spine surgery.
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Affiliation(s)
- Sazid Hasan
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - Malik Al-Jamal
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Alex Miller
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | | | - Daniel R. Cavazos
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Muhammad Waheed
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Ehab Saleh
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - Scott A. McCarty
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
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Duits AAA, van Urk PR, Lehr AM, Nutzinger D, Reijnders MRL, Weinans H, Foppen W, Oner FC, van Gaalen SM, Kruyt MC. Radiologic Assessment of Interbody Fusion: A Systematic Review on the Use, Reliability, and Accuracy of Current Fusion Criteria. JBJS Rev 2024; 12:01874474-202401000-00005. [PMID: 38194599 DOI: 10.2106/jbjs.rvw.23.00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Lumbar interbody fusion (IF) is a common procedure to fuse the anterior spine. However, a lack of consensus on image-based fusion assessment limits the validity and comparison of IF studies. This systematic review aims to (1) report on IF assessment strategies and definitions and (2) summarize available literature on the diagnostic reliability and accuracy of these assessments. METHODS Two searches were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Search 1 identified studies on adult lumbar IF that provided a detailed description of image-based fusion assessment. Search 2 analyzed studies on the reliability of specific fusion criteria/classifications and the accuracy assessed with surgical exploration. RESULTS A total of 442 studies were included for search 1 and 8 studies for search 2. Fusion assessment throughout the literature was highly variable. Eighteen definitions and more than 250 unique fusion assessment methods were identified. The criteria that showed most consistent use were continuity of bony bridging, radiolucency around the cage, and angular motion <5°. However, reliability and accuracy studies were scarce. CONCLUSION This review highlights the challenges in reaching consensus on IF assessment. The variability in IF assessment is very high, which limits the translatability of studies. Accuracy studies are needed to guide innovations of assessment. Future IF assessment strategies should focus on the standardization of computed tomography-based continuity of bony bridging. Knowledge from preclinical and imaging studies can add valuable information to this ongoing discussion. LEVEL OF EVIDENCE Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anneli A A Duits
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Orthopedic surgery, Diakonessenhuis, Utrecht, Zeist, the Netherlands
- Department of Orthopedics, Clinical Orthopedic Research Center (CORC-mN), Diakonessenhuis Utrecht/Zeist, Utrecht, the Netherlands
| | - Paul R van Urk
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A Mechteld Lehr
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Don Nutzinger
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten R L Reijnders
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Harrie Weinans
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Wouter Foppen
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - F Cuhmur Oner
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Steven M van Gaalen
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Orthopedic Surgery, Acibadem Internal Medical Center, Amsterdam, the Netherlands
| | - Moyo C Kruyt
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Developmental BioEngineering, University of Twente, Enschede, the Netherlands
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Agus Subagio E, Apriyansa Rahmadhan M, Faris M, Indarto Susilo R, Setiawan Suroto N, Utomo B, Wicaksono P, Hafid Bajamal A. Comparison of fusion outcomes of bone morphogenetics proteins-7 and bone autograft in posterolateral lumbar fusion : a systematic review. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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