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Review
. 2018 Oct;8(7):739-750.
doi: 10.1177/2192568218755141. Epub 2018 Feb 11.

Radiological Fusion Criteria of Postoperative Anterior Cervical Discectomy and Fusion: A Systematic Review

Masahito Oshina  1   2 , Yasushi Oshima  1 , Sakae Tanaka  1 , K Daniel Riew  2
Affiliations
Review

Radiological Fusion Criteria of Postoperative Anterior Cervical Discectomy and Fusion: A Systematic Review

Masahito Oshina et al. Global Spine J. 2018 Oct.

Abstract

Study design: Systematic review.

Objectives: Diagnosis of pseudarthrosis after anterior cervical fusion is difficult, and often depends on the surgeon's subjective assessment because recommended radiographic criteria are lacking. This review evaluated the available evidence for confirming fusion after anterior cervical surgery.

Methods: Articles describing assessment of anterior cervical fusion were retrieved from MEDLINE and SCOPUS. The assessment methods and fusion rates at 1 and 2 years were evaluated to identify reliable radiographical criteria.

Results: Ten fusion criteria were described. The 4 most common were presence of bridging trabecular bone between the endplates, absence of a radiolucent gap between the graft and endplate, absence of or minimal motion between adjacent vertebral bodies on flexion-extension radiographs, and absence of or minimal motion between the spinous processes on flexion-extension radiographs. The mean fusion rates were 90.2% at 1 year and 94.7% at 2 years. The fusion rate at 2 years had significant independence (P = .048).

Conclusions: The most common fusion criteria, bridging trabecular bone between the endplates and absence of a radiolucent gap between the graft and endplate, are subjective. We recommend using <1 mm of motion between spinous processes on extension and flexion to confirm fusion.

Keywords: ACDF; anterior cervical discectomy and fusion; anterior cervical fusion; arthrodesis; cervical fusion; cervical spine; dynamic radiography; fusion criteria; pseudarthrosis; spinous process.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Riew owns stock in Osprey, Expanding Orthopedics, Spineology, Spinal Kinetics, and Nexgen Spine and receives honorarium from Advanced Medical, Grand Rounds, Medtronic, Zeiss, and Zimmer Biomet. Dr Tanaka has received honoraria from Amgen Inc, Asahi Kasei Pharma Corporation, Amgen Astellas BioPharma K.K., Kyocera Medical Corporation, Daiichi Sankyo Company, Limited, Teijin Pharma Limited., Eli Lilly Japan K.K., Pfizer Japan Inc, endowments from Astellas Pharma Inc, Ayumi Pharmaceutical Corporation, Bristol-Myers Squibb, Pfizer Japan Inc, Daiichi Sankyo Company Limited, Chugai Pharmaceutical Co, Ltd, and grants from The Japan Agency for Medical Research and Development (AMED), Japan Society for the Promotion of Science (JSPS)/Grant-in-Aid for Scientific Research (A), and the Japan Society for the Promotion of Science (JSPS)/Grant-in-Aid for Exploratory Research.

Figures

Figure 1.
Figure 1.
Study selection flowchart for search of articles pertaining to radiological fusion criteria.
Figure 2.
Figure 2.
Mean fusion rate with combined fusion criteria.
See this image and copyright information in PMC

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