Medical Student Case Western Reserve University School of Medicine
Introduction: Spinal fusion is a common procedure used to relieve pain and instability of various spinal pathologies. Although there have been attempts to standardize spinal fusion assessment radiologically, there is currently no unified definition that also considers clinical symptomology. This review attempts to create a more holistic definition of successful spinal fusion.
Methods: A systematic review of the literature on spinal fusion was conducted using the PubMed, Google Scholar, and EBSCO databases. Data was extracted from over 20 publications containing information on the efficacy of imaging modalities, clinical presentations, and the normal course of healing in relation to spinal fusion. Furthermore, the extracted data was used to develop a proposed definition of successful spinal fusion.
Results: Twenty studies evaluating 1,324 spinal fusion procedures were included in the final analysis. A clinical algorithm was developed to help physicians determine the success of spinal fusion procedures. The algorithm first stratifies patients as symptomatic or asymptomatic. Asymptomatic patients were considered to have successful fusions after 12 months. If symptomatic, the imaging modality and healing characteristics were based on the quality of pain. For radicular pain, evaluation includes a flexion/extension radiograph to assess for foraminal compression, trabecular bridging, minimal angular rotation, minimal translational movement, and minimal halo sign. Axial pain is evaluated with helical CT, with success indicators including trabecular bridging, no radiolucent shadowing, no visible bone/hardware fracture, no cystic/sclerotic changes, low subsidence level near the graft, and minimal screw rod construct migration. Spinal fusion is considered “unsuccessful” if symptoms persist beyond a year post-operatively, regardless of radiographic findings
Conclusion : A standardized method for evaluating spinal fusion success was proposed that incorporates clinical symptoms, various imaging modalities, and the natural course of bone healing. The implementation of this algorithm may lead to improved postoperative evaluation and a standardized metric to assess developments in fusion technology.
.jpg)
