Radiographic Characteristics on Conventional Radiographs After Posterior Lumbar Interbody Fusion: Comparative Study Between Radiotranslucent and Radiopaque Cages

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Abstract
The problem of determining solidity of a fused spinal segment still remains. Our purpose is to evaluate radiographic findings after posterior lumbar interbody fusion (PLIF) with cages and estimate their relative value in judging fusion status. Radiographic follow-up was performed in patients after PLIF with cages of either radiotranslucent or radiopaque material. Conventional radiographs were obtained 6 weeks, 3 and 6 months, and then yearly after surgery for spinal instability for 64 patients. We differentiated between uncertain (increased density within the cage, increase of sclerotic endplates, and posterolateral fusion) and definite (trabecular continuous bone bridging within the implant and periimplant new bone formation with bridging of the intervertebral space) fusion signs. A fusion rate of 51.5% after 12 months, 61.4% after 24 months, 66.7% after 36 months, and 77.8% after 48 months postoperatively was found. We found only a slight, nonsignificant correlation between radiographic fusion and patient-assessed clinical outcome. There is evidence that radiographic fusion criteria occur in a specific chronologic order. The interpretation of fusion status is notably impaired by the use of radiopaque cages. Criteria to standardize the interpretation and evaluation of radiographic findings after PLIF are discussed.