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Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
CT-based classification of long spinal allograft fusion
G H Tan1, B G Goss, P J Thorpe
1AOSpine Reference Centre, Princess Alexandra Hospital, Woolongabba, Brisbane, Australia.
Summary
High-speed CT imaging offers a more accurate method for assessing bony union after anterior spinal reconstruction using structural allografts. This new classification system provides reproducible categorization of allograft incorporation.
Area of Science:
- Spine surgery
- Orthopedic imaging
- Biomaterials
Background:
- Anterior column reconstruction of the thoracolumbar spine often uses structural allografts for enhanced biological fusion.
- Traditional assessment of bony union via plain radiography lacks sensitivity for evaluating cortical union and trabecular in-growth.
- Accurate assessment of allograft incorporation is crucial for determining treatment efficacy and patient outcomes.
Purpose of the Study:
- To introduce and validate a novel assessment method for bony union using high-speed spiral CT imaging.
- To develop a classification system for grading allograft incorporation based on CT findings.
- To evaluate the reliability of the proposed classification system for assessing structural allograft union.
Main Methods:
- A prospective study involving 25 patients with single-level thoracolumbar burst fractures (T4-L5) undergoing anterior spinal reconstruction with structural allografts.
- High-speed spiral CT scans were performed at a minimum of two years post-operatively to evaluate the reconstructed segment.
- A four-grade classification system (Grade I-IV) was developed to categorize bony union based on cortical and trabecular continuity.
Main Results:
- The proposed classification system demonstrated high interobserver reliability (kappa = 0.91) and intraobserver reliability (kappa = 0.95).
- High-speed CT imaging provided detailed visualization of cortical union and trabecular in-growth, reflecting biological stability.
- The classification system allowed for reproducible categorization of structural allograft incorporation, differentiating between complete fusion, partial fusion, and non-union.
Conclusions:
- High-speed CT imaging is a valuable tool for accurately assessing bony union in structural allografts used for thoracolumbar spine reconstruction.
- The developed classification system offers a reliable and reproducible method for categorizing allograft incorporation.
- This imaging and classification approach has significant implications for treatment planning and monitoring in patients undergoing anterior spinal reconstruction.
