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European Spine Journal

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01-03-2016 | Original Article

Quantitative in vivo fusion assessment by ¹⁸F-fluoride PET/CT following en bloc spondylectomy

Authors: Matthias Pumberger, Vikas Prasad, Claudia Druschel, Alexander C. Disch, Winfried Brenner, Klaus-Dieter Schaser

Published in: European Spine Journal | Issue 3/2016

Abstract

Purpose

The purpose of this retrospective analyses was to evaluate the bone viability in the ventral column of the spine following large segmental defect reconstructions. Osseous integration of implants following spinal fusion procedures is an essential precondition to provide adequate mechanical strength to any applied forces and subsequently satisfying patient outcomes. Although CT scan is the non-invasive gold standard for fusion assessment, it lacks the ability to visualize bone viability and, therefore, discrepancy remains about sensitivity and specificity of CT as evaluation tool of spinal fusion.

Methods

A novel modality, ¹⁸F Fluoride PET/CT, specifically allows quantitative in vivo evaluation of metabolic activity of the osseous integration. Bone viability following large segmental reconstructions in patients after mono- and multi-level en bloc spondylectomies (EBS) was analyzed. Spinal fusion was assessed on plain radiographs and CT scans according to the FDA fusion criteria as well as ¹⁸F PET/CT.

Results

A total of eight patients underwent ¹⁸F PET/CT were included (one 4-level-, one 3-level, two 2-level and four 1-level EBS). The average follow-up between EBS and radiographic studies was 24.8 months. On plain radiographs and CT scans, successful fusion was confirmed in all patients. However, ¹⁸F PET/CT showed non-union in all cases. The metabolic bone activity within the cage was fourfold decreased compared to the reference vertebra, whereas the metabolic activity of the adjacent endplates was 1.6-fold increased compared to the reference vertebra.

Conclusion

This study suggests a discrepancy between fusion rates assessed by plain radiographs and CT scan compared to ¹⁸F PET/CT.

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Title: Quantitative in vivo fusion assessment by 18F-fluoride PET/CT following en bloc spondylectomy
Authors: Matthias Pumberger
Vikas Prasad
Claudia Druschel
Alexander C. Disch
Winfried Brenner
Klaus-Dieter Schaser
Publication date: 01-03-2016
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 3/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-015-4121-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Quantitative in vivo fusion assessment by ¹⁸F-fluoride PET/CT following en bloc spondylectomy

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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