Diagnosis of reoperated cervical non-union: Multicenter retrospective study about 45 patients - 17/04/21

Doi : 10.1016/j.otsr.2021.102924

Maxime Huneidi ^a,⁎ , Yves Ntilikina ^b, Ibrahim Obeid ^a, Benjamin Bouyer ^a, Fahed Zairi ^c, Paulo Marinho ^d, Yann-Philippe Charles ^b, Jean-Marc Vital ^a, Olivier Gille ^a, Louis Boissière ^a
^a Centre Hospitalier Universitaire de Bordeaux, Unité de Chirurgie Rachidienne, CHU Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France
^b Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, 1, Place de l’Hôpital, BP 426, 67091 Strasbourg Cedex, France
^c CHRU de Lille, Hôpital Roger-Salengro, Service de Neurochirurgie, Rue Emile-Laine, 59037 Lille Cedex, France
^d Centre du Rachis de la Sauvegarde, 29b, Avenue des Sources, 69009 Lyon, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 17 April 2021
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Abstract

Introduction

Non-union is one of the main complications of single- or multi-level cervical spine fusion, considerably impairing functional results. The aim of this study was to evaluate the respective contributions of imaging examinations in the diagnostic process, the challenge being to avoid inappropriate surgery and unnecessary complementary examinations.

Material and method

A retrospective multicenter study included all patients managed for cervical spine non-union between 2008 and 2018. We evaluated the imaging examinations performed on each patient and determined signs of non-union in each image.

Results

The study included 45 patients in 4 centers: 55% female; mean age, of 48±8.0 years; 57% smokers. Systematic static radiography showed signs of non-union in 55% of cases. Dynamic X-ray was performed in 34% of patients, and showed hypermobility of the level in 80% of cases. CT supported diagnosis of non-union in 97% of cases, and MRI in 48%. SPECT-CT was positive in all cases of non-union.

Discussion

Dynamic X-ray is rarely prescribed, but frequently provided an objective measure of hypermobility of the level in non-union, justifying first-line use. Millimetric-slice CT was reliable for diagnosis. MRI is relevant only once diagnosis has been made, as part of preoperative work-up. Nuclear imaging can be useful in order to solve doubtful cases.