Fusion and Healing Prediction in Posterolateral Spinal Fusion Using 18F-Sodium Fluoride-PET/CT

Caius M Constantinescu,Caius M Constantinescu,Poul F Høilund-Carlsen,Poul F Høilund-Carlsen,Mikkel Ø Andersen,Mikkel Ø Andersen,Michael K Jacobsen,Oke Gerke,Oke Gerke

doi:10.3390/diagnostics10040226

Caius M Constantinescu, Caius M Constantinescu + Show 7 more

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https://doi.org/10.3390/diagnostics10040226

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Abstract

This study measures the total graft of 18F-sodium fluoride (NaF) uptake in non-instrumented posterolateral lumbar fusion (niPLF) patients one month after surgery and correlates it with the difference in the clinical findings between the baseline and one year after surgery. The walking distance (WLK-D), visual analog scale of back pain (VAS-B), VAS score of leg pain (VAS-L), tandem test (TAN), Oswestry Disability Index questionnaire (ODI), and European Quality of Life-5 Dimensions questionnaire (EQ-5D) were assessed before surgery and one year after. The graft NaF uptake was analyzed quantitatively with a fixed threshold algorithm resulting in the total graft uptake (SUVtotal) and partial volume corrected SUVtotal (cSUVtotal). Only 4 out of 18 patients experienced fusion; they had an insignificantly lower median total graft uptakes, i.e., 1178 SUVtotal vs. 1224 SUVtotal (p = 0.73) and 1282 cSUVtotal vs. 1231 cSUVtotal (p = 0.35), respectively. Similarly, fused patients experienced insignificantly larger pain decreases, i.e., median VAS-B 4.3 vs. 3.8 (p = 0.92) and VAS-L −6.4 vs. −4.4 (p = 0.2). We found an insignificant trend for a lower NaF uptake and less pain in fused patients. The NaF uptake did not correlate with the chronological change in the clinical parameters.

Highlights

In Denmark, more than 2200 patients underwent surgery for lumbar spinal stenosis in 2017, and about 270 of those had degenerative spondylolisthesis [1]
We only look at the baseline and one-year clinical assessment focusing on the following parameters: the walking distance (WLK-D), visual analog scale (VAS) of back pain (VAS-B), VAS of leg pain (VAS-L), tandem test (TAN), Oswestry Disability Index questionnaire (ODI), and European Quality of
Fused patients had a median age of 67 years, BMI of 26.5, WLK-D of 264, visual analog scale of back pain (VAS-B) of

Summary

Introduction

In Denmark, more than 2200 patients underwent surgery for lumbar spinal stenosis in 2017, and about 270 of those had degenerative spondylolisthesis [1]. The treatment in those cases consisted of surgical decompression with a supplementary non-instrumented spinal fusion (niPLF). Obtaining an adequate fusion in elderly patients is challenging due to poorer osteoblast proliferation [2]. A solid fusion in patients with degenerative spondylolisthesis is paramount as reoperation rates decline [3,4]. Fusion is only obtained in one third of patients [5]. In order to improve the fusion rate, different alternative fusion enhancers have been proposed, one of the latest being ABM/P-15 (iFactor Cerapedics Inc., Westminster, CO, USA)

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