Contribution of MRI and imaging exams in the diagnosis of lumbar pseudarthrosis

IF 2.3 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research Pub Date : 2025-05-01 DOI:10.1016/j.otsr.2024.103817

Maxime Huneidi , Pawel P. Jankowski , Benjamin Bouyer , Camille Damade , Jean-Marc Vital , Olivier Gille , Louis Boissière

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引用次数: 0

Abstract

Introduction

The diagnosis of pseudoarthrosis is based on imaging and clinical exam findings. The standard for pseudarthrosis diagnosis remains postoperative observation through computer tomography (CT) and patient's symptoms. This can be further augmented by dynamic X-ray imaging or nuclear positron emission tomography (PET) CT to demonstrate an absence of fusion by showing a persistence of mobility. However, there is not a uniform diagnostic approach that is a standard of care amongst spine practioners. The aim of this study is to describe the timeline and diagnostic analysis for pseudoarthrosis between the initial surgery and follow-up procedure.

Methods

This is a single-center retrospective observational study. The aim was to enroll patients reoperated for pseudarthrosis after 1 or 2 level lumbar fusions, between August 1st, 2008 and August 1st, 2018. The exams were reviewed by one surgeon and one radiologist, defining a status either in favor of pseudarthrosis, or against it, or inconclusive, based on the radiological criteria mentioned below. We then investigated different combinations of exams and their specific chronology before a diagnosis was established.

Results

Forty-four patients were included, 70.5% male and with a mean age of 47.3 years. The median time between the 2 surgeries was 23.7 months. Plain X-rays supported the diagnosis in 38.7% of cases, dynamic X-rays showed hypermobility in 50% of cases. The CT-scan demonstrated pseudarthrosis in 94,4% of cases. A MODIC 1 signal was observed in 87,2% of cases on MRI. SPECT-CT showed a tracer uptake in 70% of cases.

Conclusion

Reducing the time to reintervention is a key objective for improving the management and clinical outcomes of these patients. We suggest that MRI is an additional tool in combination with CT in the assessment of suspected mechanical pseudarthrosis, in order to optimize the diagnosis and shorten the time to revision surgery.

Level of evidence

IV.

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磁共振成像和影像学检查在诊断腰椎假关节中的作用

导言：假关节的诊断基于影像学和临床检查结果。假关节诊断的标准仍然是通过计算机断层扫描（CT）和患者症状进行术后观察。动态X光成像或核素正电子发射断层扫描（PET）CT可进一步增强这一诊断，通过显示持续的活动度来证明没有融合。然而，目前还没有一种统一的诊断方法成为脊柱科医生的护理标准。本研究旨在描述初次手术和后续手术之间假关节的时间轴和诊断分析：这是一项单中心回顾性观察研究。检查结果由一名外科医生和一名放射科医生共同审查，根据以下放射学标准确定假关节状态，或支持假关节，或反对假关节，或不确定假关节：44名患者中，70.5%为男性，平均年龄为47.3岁。两次手术之间的中位时间为 23.7 个月。38.7%的病例经普通X光检查确诊，50%的病例经动态X光检查显示活动度过大。CT扫描显示94.4%的病例存在假关节。87.2%的病例在磁共振成像中观察到 MODIC 1 信号。SPECT-CT显示70%的病例存在示踪剂摄取：结论：缩短重新介入治疗的时间是改善这些患者的管理和临床疗效的关键目标。我们建议在评估疑似机械性假关节时将核磁共振成像与 CT 结合使用，以优化诊断并缩短翻修手术的时间：证据等级：IV。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Orthopaedics & Traumatology-Surgery & Research 医学-外科

CiteScore

5.10

自引率

26.10%

发文量

329

审稿时长

12.5 weeks

期刊介绍： Orthopaedics & Traumatology: Surgery & Research (OTSR) publishes original scientific work in English related to all domains of orthopaedics. Original articles, Reviews, Technical notes and Concise follow-up of a former OTSR study are published in English in electronic form only and indexed in the main international databases.