Documenting fusion following anterior cervical surgery: a comparison of roentgenogram versus two-dimensional computed...

Documentation of fusion following anterior cervical surgery may critically influence management strategies that can adversely affect outcome. Would two-dimensional CT studies more accurately identify fusion following single-level anterior corpectomy with fusion compared with radiographic studies (plain/dynamic) alone? To answer this question, two radiologists, in a "blinded" fashion, separately read both radiographic and two-dimensional CT studies obtained 3 and 6 months following 46 single-level anterior corpectomy with fusion. Single-level anterior corpectomy with fusion used nonreversed iliac crest strut autografts and dynamic ABC plates (Aesculap, Tuttlingen, Germany). Following surgery, patients were immobilized in cervicothoracic orthoses, which were discontinued when fusion was confirmed. Patients were followed an average of 3.2 years (minimum 2 years). Outcomes were measured with the Short Form-36 questionnaire administered preoperatively, and 3, 6, and 12 months postoperatively. Three months after surgery, radiographs documented fusion in 38 (83%) of 46 patients, whereas two-dimensional CTs confirmed fusion in only 23 (50%) of 46 patients. Six months postoperatively, radiographs documented fusion in 44 (96%) of 46 patients, whereas only 32 (70%) of 46 patients were solidly fused on two-dimensional CT studies. Three and 6 months following single-level anterior corpectomy with fusion, two-dimensional CT scans more accurately confirmed fusion compared with radiographs alone.