Pseudarthrosis following lumbar fusion: detection by direct coronal CT scanning

Twenty patients with fusions of the lumbar spine (seven with pseudarthrosis, 11 with solid bony fusions, and two with fusions that appeared solid but assessment was complicated by the presence of surgical hardware) underwent computed tomographic (CT) scanning in the supine position in the axial plane and, employing a specially designed seat, in the coronal plane. Three-millimeter contiguous sections were acquired. The direct coronal images were compared with those reformated from the axial images. The higher-resolution direct coronal images facilitated the diagnosis of pseudarthrosis and increased confidence in interpretation of normal studies. Direct coronal imaging is easy to perform and in many cases requires fewer scans and less radiation than reformations. Because it provides more useful diagnostic information, direct coronal imaging should replace current methods for evaluating fusions of the lumbar spine.