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A New Volumetric Radiologic Method to Assess Indirect Decompression After Extreme Lateral Interbody Fusion Using High-Resolution Intraoperative Computed Tomography.

TitleA New Volumetric Radiologic Method to Assess Indirect Decompression After Extreme Lateral Interbody Fusion Using High-Resolution Intraoperative Computed Tomography.
Publication TypeJournal Article
Year of Publication2018
AuthorsNavarro-Ramirez R, Berlin C, Lang G, Hussain I, Janssen I, Sloan S, Askin G, Avila MJ, Zubkov M, Härtl R
JournalWorld Neurosurg
Volume109
Pagination59-67
Date Published2018 Jan
ISSN1878-8769
KeywordsAged, Aged, 80 and over, Decompression, Surgical, Female, Humans, Image Processing, Computer-Assisted, Intraoperative Care, Lumbar Vertebrae, Male, Middle Aged, Organ Size, Retrospective Studies, Spinal Canal, Spinal Fusion, Spinal Stenosis, Tomography, X-Ray Computed
Abstract

BACKGROUND: Two-dimensional radiographic methods have been proposed to evaluate the radiographic outcome after indirect decompression through extreme lateral interbody fusion (XLIF). However, the assessment of neural decompression in a single plane may underestimate the effect of indirect decompression on central canal and foraminal volumes. The present study aimed to assess the reliability and consistency of a novel 3-dimensional radiographic method that assesses neural decompression by volumetric analysis using a new generation of intraoperative fan-beam computed tomography scanner in patients undergoing XLIF.

METHODS: Prospectively collected data from 7 patients (9 levels) undergoing XLIF was retrospectively analyzed. Three independent, blind raters using imaging analysis software performed volumetric measurements pre- and postoperatively to determine central canal and foraminal volumes. Intrarater and Interrater reliability tests were performed to assess the reliability of this novel volumetric method.

RESULTS: The interrater reliability between the three raters ranged from 0.800 to 0.952, P < 0.0001. The test-retest analysis on a randomly selected subset of three patients showed good to excellent internal reliability (range of 0.78-1.00) for all 3 raters. There was a significant increase in mean volume ≈20% for right foramen, left foramen, and central canal volumes postoperatively (P = 0.0472; P = 0.0066; P = 0.0003, respectively).

CONCLUSIONS: Here we demonstrate a new volumetric analysis technique that is feasible, reliable, and reproducible amongst independent raters for central canal and foraminal volumes in the lumbar spine using an intraoperative computed tomography scanner.

DOI10.1016/j.wneu.2017.07.155
Alternate JournalWorld Neurosurg
PubMed ID28826705