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Pseudarthrosis after lumbar spinal fusion: the role of ¹⁸F-fluoride PET/CT.

Peters M, Willems P, Weijers R, Wierts R, Jutten L, Urbach C, Arts C, van Rhijn L, Brans B - Eur. J. Nucl. Med. Mol. Imaging (2015)

Bottom Line: Patients were divided into three categories based on these questionnaire scores.However, (18)F-fluoride activity in the vertebral endplates was significantly higher in patients in the lowest Oswestry Disability Index category (i.e. with the worst clinical performance) than in patients in higher categories (p = 0.01 between categories 1 and 2 and 1 and 3).The visual analogue scale and EuroQol results were similar although less pronounced, with only SUVmax between category 1 and 2 being significantly different (p = 0.04).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Maastricht University Medical Center, Postbox 5800, 6202 AZ, Maastricht, The Netherlands. marloes.peters@mumc.nl.

ABSTRACT

Purpose: Painful pseudarthrosis is one of the most important indications for (revision) surgery after spinal fusion procedures. If pseudarthrosis is the source of recurrent pain it may require revision surgery. It is therefore of great clinical importance to ascertain if it is the source of such pain. The correlation between findings on conventional imaging (plain radiography and CT) and clinical well-being has been shown to be moderate. The goal of this study was to determine the possible role of (18)F-fluoride PET in patients after lumbar spinal interbody fusion by investigating the relationship between PET/CT findings and clinical function and pain.

Methods: A cohort of 36 patients was retrospectively included in the study after (18)F-fluoride PET/CT for either persistent or recurrent low back pain (18 patients) or during routine postoperative investigation (18 patients) between 9 and 76 months and 11 and 14 months after posterior lumbar interbody fusion, respectively. Sixty minutes after intravenous injection of 156 - 263 MBq (mean 199 MBq, median 196 MBq) (18)F-fluoride, PET and CT images were acquired using an integrated PET/CT scanner, followed by a diagnostic CT scan. Two observers independently scored the images. The number of bony bridges between vertebrae was scored on the CT images to quantify interbody fusion (0, 1 or 2). Vertebral endplate and intervertebral disc space uptake were evaluated visually as well as semiquantitatively following (18)F-fluoride PET. Findings on PET and CT were correlated with clinical wellbeing as measured by validated questionnaires concerning general daily functioning (Oswestry Disability Index), pain (visual analogue scale) and general health status (EuroQol). Patients were divided into three categories based on these questionnaire scores.

Results: No correlation was found between symptom severity and fusion status. However, (18)F-fluoride activity in the vertebral endplates was significantly higher in patients in the lowest Oswestry Disability Index category (i.e. with the worst clinical performance) than in patients in higher categories (p = 0.01 between categories 1 and 2 and 1 and 3). The visual analogue scale and EuroQol results were similar although less pronounced, with only SUVmax between category 1 and 2 being significantly different (p = 0.04).

Conclusion: We hypothesize that (18)F-fluoride PET/CT may be able to provide support for the diagnosis of painful pseudarthrosis and could serve as a tool to discriminate between symptomatic and asymptomatic pseudarthrosis for revision surgery, as CT defines the consolidation status and PET pinpoints the 'stress reaction' at the vertebral endplates which significantly correlates with Oswestry Disability Index score.

No MeSH data available.


Related in: MedlinePlus

Relationship between CT fusion scores and SUVmax ratios. SUVratioU and SUVratioL in patients with pseudarthrosis (CT fusion score 0) were significantly higher than in patients with score 1 or 2 (*p < 0.05, **p < 0.01)
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Fig6: Relationship between CT fusion scores and SUVmax ratios. SUVratioU and SUVratioL in patients with pseudarthrosis (CT fusion score 0) were significantly higher than in patients with score 1 or 2 (*p < 0.05, **p < 0.01)

Mentions: Fig. 6 shows the relationship between 18F-fluoride activity on PET (i.e. SUVratioU and SUVratioL) and CT fusion scores. There were a significant correlation, with SUVratioU values of 1.4 ± 0.4 for fusion score 0, 1.2 ± 0.3 for fusion score 1, and 1.0 ± 0.2 for fusion score 3 (p = 0.04 between scores 0 and 1, p = 0.003 between scores 0 and 2, p = 0.09 between scores 1 and 2). For the lower endplate similar statistically significant results were found. SUVratioU values were 1.5 ± 0.6 for fusion score 0, 1.1 ± 0.3 for fusion score 1 and 1.0 ± 0.3 for fusion score 3 (p = 0.05 between scores 0 and 1, p = 0.003 between scores 0 and 2, p = 0.29 between scores 1 and 2). Interestingly, the PET activity ratio in patients with fusion score 1 was not significantly lower than in patients with fusion score 2.Fig. 6


Pseudarthrosis after lumbar spinal fusion: the role of ¹⁸F-fluoride PET/CT.

Peters M, Willems P, Weijers R, Wierts R, Jutten L, Urbach C, Arts C, van Rhijn L, Brans B - Eur. J. Nucl. Med. Mol. Imaging (2015)

Relationship between CT fusion scores and SUVmax ratios. SUVratioU and SUVratioL in patients with pseudarthrosis (CT fusion score 0) were significantly higher than in patients with score 1 or 2 (*p < 0.05, **p < 0.01)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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Fig6: Relationship between CT fusion scores and SUVmax ratios. SUVratioU and SUVratioL in patients with pseudarthrosis (CT fusion score 0) were significantly higher than in patients with score 1 or 2 (*p < 0.05, **p < 0.01)
Mentions: Fig. 6 shows the relationship between 18F-fluoride activity on PET (i.e. SUVratioU and SUVratioL) and CT fusion scores. There were a significant correlation, with SUVratioU values of 1.4 ± 0.4 for fusion score 0, 1.2 ± 0.3 for fusion score 1, and 1.0 ± 0.2 for fusion score 3 (p = 0.04 between scores 0 and 1, p = 0.003 between scores 0 and 2, p = 0.09 between scores 1 and 2). For the lower endplate similar statistically significant results were found. SUVratioU values were 1.5 ± 0.6 for fusion score 0, 1.1 ± 0.3 for fusion score 1 and 1.0 ± 0.3 for fusion score 3 (p = 0.05 between scores 0 and 1, p = 0.003 between scores 0 and 2, p = 0.29 between scores 1 and 2). Interestingly, the PET activity ratio in patients with fusion score 1 was not significantly lower than in patients with fusion score 2.Fig. 6

Bottom Line: Patients were divided into three categories based on these questionnaire scores.However, (18)F-fluoride activity in the vertebral endplates was significantly higher in patients in the lowest Oswestry Disability Index category (i.e. with the worst clinical performance) than in patients in higher categories (p = 0.01 between categories 1 and 2 and 1 and 3).The visual analogue scale and EuroQol results were similar although less pronounced, with only SUVmax between category 1 and 2 being significantly different (p = 0.04).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Maastricht University Medical Center, Postbox 5800, 6202 AZ, Maastricht, The Netherlands. marloes.peters@mumc.nl.

ABSTRACT

Purpose: Painful pseudarthrosis is one of the most important indications for (revision) surgery after spinal fusion procedures. If pseudarthrosis is the source of recurrent pain it may require revision surgery. It is therefore of great clinical importance to ascertain if it is the source of such pain. The correlation between findings on conventional imaging (plain radiography and CT) and clinical well-being has been shown to be moderate. The goal of this study was to determine the possible role of (18)F-fluoride PET in patients after lumbar spinal interbody fusion by investigating the relationship between PET/CT findings and clinical function and pain.

Methods: A cohort of 36 patients was retrospectively included in the study after (18)F-fluoride PET/CT for either persistent or recurrent low back pain (18 patients) or during routine postoperative investigation (18 patients) between 9 and 76 months and 11 and 14 months after posterior lumbar interbody fusion, respectively. Sixty minutes after intravenous injection of 156 - 263 MBq (mean 199 MBq, median 196 MBq) (18)F-fluoride, PET and CT images were acquired using an integrated PET/CT scanner, followed by a diagnostic CT scan. Two observers independently scored the images. The number of bony bridges between vertebrae was scored on the CT images to quantify interbody fusion (0, 1 or 2). Vertebral endplate and intervertebral disc space uptake were evaluated visually as well as semiquantitatively following (18)F-fluoride PET. Findings on PET and CT were correlated with clinical wellbeing as measured by validated questionnaires concerning general daily functioning (Oswestry Disability Index), pain (visual analogue scale) and general health status (EuroQol). Patients were divided into three categories based on these questionnaire scores.

Results: No correlation was found between symptom severity and fusion status. However, (18)F-fluoride activity in the vertebral endplates was significantly higher in patients in the lowest Oswestry Disability Index category (i.e. with the worst clinical performance) than in patients in higher categories (p = 0.01 between categories 1 and 2 and 1 and 3). The visual analogue scale and EuroQol results were similar although less pronounced, with only SUVmax between category 1 and 2 being significantly different (p = 0.04).

Conclusion: We hypothesize that (18)F-fluoride PET/CT may be able to provide support for the diagnosis of painful pseudarthrosis and could serve as a tool to discriminate between symptomatic and asymptomatic pseudarthrosis for revision surgery, as CT defines the consolidation status and PET pinpoints the 'stress reaction' at the vertebral endplates which significantly correlates with Oswestry Disability Index score.

No MeSH data available.


Related in: MedlinePlus