Abstract：
BACKGROUND: Currently, there is no universally accepted method for assessing radiological fusion shortly after anterior cervical discectomy. Five-year follow-up radiological X-rays demonstrating solid fusion or absence of fusion provided a gold standard for comparison with various assessment methods.
OBJECTIVE: Establishing the most accurate diagnostic test for earlier bony fusion assessment by comparing different cut-off values for the difference in interspinous distance and the change in Cobb angle on dynamic radiological images against the established gold standard.
METHODS: Post-hoc analysis from the NEtherlands Cervical Kinematics (NECK) trial (NTR1289).
METHODS: A total of 40 patients with 1 level herniated disc that underwent anterior discectomy between 2010 and 2014 returned for a 5-year follow-up X-ray.
METHODS: Radiological outcome was assessed quantitatively and qualitatively by fusion on radiographic images 5 years after surgery.
METHODS: Radiological dynamic X-rays were reviewed for fusion at 5-year follow-up by a senior spine surgeon. At this timepoint, bony continuity was indisputable and served as gold standard. Cobb angles and interspinous distances on flexion-extension images were measured independently by 2 investigators. Optimum agreement between the gold standard and the 2 methods was assessed, evaluating varying cut-off values, considering sensitivity, specificity, and area under the curve (AUC).
RESULTS: Dynamic radiographic assessments revealed fusion in 29 out of 40 patients (mean age: 49 years ± 8; 23 women). For Cobb angle (optimal cut-off: ≤3.0°), the AUC was 0.86 with 100% sensitivity and 72.7% specificity. For interspinous distance (optimal cut-off: ≤1.5 mm), the AUC was 0.89 with 96.6% sensitivity and 81.8% specificity. The highest AUC (0.91) was observed for combined cut-off values (Cobb angle ≤3.0° and interspinous distance ≤2.0 mm), yielding 100% sensitivity and 81.8% specificity.
CONCLUSIONS: The combination of cut-off values ≤3.0° difference for Cobb angle and ≤2.0 mm difference for interspinous distance on lateral flexion-extension X-rays was assessed to be an accurate diagnostic criterion for fusion evaluation. This tool provides a practical and easy applicable method for assessing fusion during follow-up after anterior discectomy.
OBJECTIVE: Establishing the most accurate diagnostic test for earlier bony fusion assessment by comparing different cut-off values for the difference in interspinous distance and the change in Cobb angle on dynamic radiological images against the established gold standard.
METHODS: Post-hoc analysis from the NEtherlands Cervical Kinematics (NECK) trial (NTR1289).
METHODS: A total of 40 patients with 1 level herniated disc that underwent anterior discectomy between 2010 and 2014 returned for a 5-year follow-up X-ray.
METHODS: Radiological outcome was assessed quantitatively and qualitatively by fusion on radiographic images 5 years after surgery.
METHODS: Radiological dynamic X-rays were reviewed for fusion at 5-year follow-up by a senior spine surgeon. At this timepoint, bony continuity was indisputable and served as gold standard. Cobb angles and interspinous distances on flexion-extension images were measured independently by 2 investigators. Optimum agreement between the gold standard and the 2 methods was assessed, evaluating varying cut-off values, considering sensitivity, specificity, and area under the curve (AUC).
RESULTS: Dynamic radiographic assessments revealed fusion in 29 out of 40 patients (mean age: 49 years ± 8; 23 women). For Cobb angle (optimal cut-off: ≤3.0°), the AUC was 0.86 with 100% sensitivity and 72.7% specificity. For interspinous distance (optimal cut-off: ≤1.5 mm), the AUC was 0.89 with 96.6% sensitivity and 81.8% specificity. The highest AUC (0.91) was observed for combined cut-off values (Cobb angle ≤3.0° and interspinous distance ≤2.0 mm), yielding 100% sensitivity and 81.8% specificity.
CONCLUSIONS: The combination of cut-off values ≤3.0° difference for Cobb angle and ≤2.0 mm difference for interspinous distance on lateral flexion-extension X-rays was assessed to be an accurate diagnostic criterion for fusion evaluation. This tool provides a practical and easy applicable method for assessing fusion during follow-up after anterior discectomy.
摘要：
背景：目前，没有普遍接受的方法来评估颈前路椎间盘切除术后不久的放射学融合。五年随访的放射X射线证明了固体融合或不存在融合，为与各种评估方法进行比较提供了金标准。
目的：通过比较动态放射图像上棘突间距离差异和Cobb角变化的不同截止值，为早期骨融合评估建立最准确的诊断测试。
方法：来自Netherland颈椎运动学（NECK）试验（NTR1289）的事后分析。
方法：2010-2014年间，共有40例一期椎间盘突出症患者接受了前路椎间盘切除术，并进行了为期5年的X线随访。
方法：在手术后5年的放射图像上通过融合对放射学结果进行定量和定性评估。
方法：一位资深脊柱外科医生在5年的随访中回顾了放射学动态X射线融合。在这个时间点,骨的连续性是无可争议的，是黄金标准。由两名研究人员独立测量屈伸图像上的Cobb角和棘突间距离。评估了黄金标准和两种方法之间的最佳一致性，评估不同的截止值，考虑到灵敏度，特异性，和曲线下面积(AUC)。
结果：动态影像学评估显示，40例患者中有29例发生融合（平均年龄：49岁±8岁；23名女性）。对于Cobb角（最佳截止：≤3.0°），AUC为0.86,敏感性为100%,特异性为72.7%.对于棘突间距离（最佳截距：≤1.5mm），AUC为0.89,敏感性为96.6%,特异性为81.8%.对于组合截止值（Cobb角≤3.0°和棘突间距离≤2.0mm），观察到最高的AUC（0.91），产生100%的灵敏度和81.8%的特异性。
结论：在侧屈伸X射线上，Cobb角的截止值差异≤3.0°和棘突间距离差异≤2.0mm的组合被评估为融合评估的准确诊断标准。该工具为前路椎间盘切除术后随访期间评估融合提供了一种实用且简便的方法。
目的：通过比较动态放射图像上棘突间距离差异和Cobb角变化的不同截止值，为早期骨融合评估建立最准确的诊断测试。
方法：来自Netherland颈椎运动学（NECK）试验（NTR1289）的事后分析。
方法：2010-2014年间，共有40例一期椎间盘突出症患者接受了前路椎间盘切除术，并进行了为期5年的X线随访。
方法：在手术后5年的放射图像上通过融合对放射学结果进行定量和定性评估。
方法：一位资深脊柱外科医生在5年的随访中回顾了放射学动态X射线融合。在这个时间点,骨的连续性是无可争议的，是黄金标准。由两名研究人员独立测量屈伸图像上的Cobb角和棘突间距离。评估了黄金标准和两种方法之间的最佳一致性，评估不同的截止值，考虑到灵敏度，特异性，和曲线下面积(AUC)。
结果：动态影像学评估显示，40例患者中有29例发生融合（平均年龄：49岁±8岁；23名女性）。对于Cobb角（最佳截止：≤3.0°），AUC为0.86,敏感性为100%,特异性为72.7%.对于棘突间距离（最佳截距：≤1.5mm），AUC为0.89,敏感性为96.6%,特异性为81.8%.对于组合截止值（Cobb角≤3.0°和棘突间距离≤2.0mm），观察到最高的AUC（0.91），产生100%的灵敏度和81.8%的特异性。
结论：在侧屈伸X射线上，Cobb角的截止值差异≤3.0°和棘突间距离差异≤2.0mm的组合被评估为融合评估的准确诊断标准。该工具为前路椎间盘切除术后随访期间评估融合提供了一种实用且简便的方法。
