18F-NaF PET/CT in Presumed Aseptic Pseudarthrosis after Spinal Fusion: Correlation with Findings at Revision Surgery and Intraoperative Cultures
Background Conventional imaging is useful to assess interbody fusion by showing complete trabecular bony bridging, but has a low positive predictive value for pseudarthrosis. Because alterations of bone metabolism may precede structural anatomical changes on computed tomography (CT), we aimed to inv...
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2022-12-01
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| Series: | World Journal of Nuclear Medicine |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1750400 |
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| author | Yacine El Yaagoubi Jean-Edouard Loret Eric Lioret Clément Thomas Adrien Simonneau Laurent Vinikoff Caroline Prunier-Aesch Alain Chetanneau Laurent Philippe Maja Ogielska Louis Bernard |
| author_facet | Yacine El Yaagoubi Jean-Edouard Loret Eric Lioret Clément Thomas Adrien Simonneau Laurent Vinikoff Caroline Prunier-Aesch Alain Chetanneau Laurent Philippe Maja Ogielska Louis Bernard |
| author_sort | Yacine El Yaagoubi |
| collection | DOAJ |
| description | Background Conventional imaging is useful to assess interbody fusion by showing complete trabecular bony bridging, but has a low positive predictive value for pseudarthrosis. Because alterations of bone metabolism may precede structural anatomical changes on computed tomography (CT), we aimed to investigate the ability of fluorine 18 sodium fluoride positron emission tomography/computed tomography (18F-NaF PET/CT) to identify pseudarthrosis after spinal fusion using surgical revision as the reference standard.
Methods We retrospectively reviewed 18F-NaF PET/CT scans performed between February 2019 and September 2020 in patients experiencing pain after spinal fusion. We included the 18 patients who underwent revision surgery for suspicion of pseudarthrosis. Five consecutive patients who were clearly fused on CT served as the control group.
Results In the revision surgery group (n=18), visual assessment by 18F-NaF PET/CT revealed that all 22 cages with an increased 18F-NaF uptake around intercorporal fusion material had mobility at revision surgery, whereas none of the fused patients (n=5) showed uptake around cage/intervertebral disk space. Among the 18 patients with presumed aseptic pseudarthrosis, intraoperative cultures revealed surgical site infection (SSI) caused by Cutibacterium acnes (C. acnes) in seven patients (38.9%). There was a statistically significant difference in standardized uptake values and uptake ratios between the revision surgery and control groups (p=5.3× 10−6 and p=0.0002, respectively).
Conclusions 18F-NaF PET/CT imaging appeared as a useful tool to identify pseudarthrosis following spinal fusion. The unexpectedly high prevalence (38.9%) of SSI caused by C. acnes found in presumed aseptic patients supports the utility of intraoperative cultures in revision cases for pseudarthrosis, even without preoperative clinical suspicion of SSI. |
| format | Article |
| id | doaj-art-9b83e15cd14c4a288e3bc33d4a0f301d |
| institution | OA Journals |
| issn | 1450-1147 1607-3312 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | World Journal of Nuclear Medicine |
| spelling | doaj-art-9b83e15cd14c4a288e3bc33d4a0f301d2025-08-20T02:00:34ZengThieme Medical and Scientific Publishers Pvt. Ltd.World Journal of Nuclear Medicine1450-11471607-33122022-12-01210430231310.1055/s-0042-175040018F-NaF PET/CT in Presumed Aseptic Pseudarthrosis after Spinal Fusion: Correlation with Findings at Revision Surgery and Intraoperative CulturesYacine El Yaagoubi0Jean-Edouard Loret1Eric Lioret2Clément Thomas3Adrien Simonneau4Laurent Vinikoff5Caroline Prunier-Aesch6Alain Chetanneau7Laurent Philippe8Maja Ogielska9Louis Bernard10Department of Nuclear Medicine, Vinci Clinic, Alexandre Minkowski, Chambray-lès-Tours, FranceDepartment of Neurosurgery, NCT+ Clinic, Saint-Cyr-sur-Loire, FranceDepartment of Neurosurgery, Vinci Clinic, Alexandre Minkowski, Chambray-lès-Tours, FranceDepartment of Neurosurgery, Vinci Clinic, Alexandre Minkowski, Chambray-lès-Tours, FranceDepartment of Neurosurgery, NCT+ Clinic, Saint-Cyr-sur-Loire, FranceDepartment of Neurosurgery, NCT+ Clinic, Saint-Cyr-sur-Loire, FranceDepartment of Nuclear Medicine, Vinci Clinic, Alexandre Minkowski, Chambray-lès-Tours, FranceDepartment of Nuclear Medicine, Vinci Clinic, Alexandre Minkowski, Chambray-lès-Tours, FranceDepartment of Nuclear Medicine, Vinci Clinic, Alexandre Minkowski, Chambray-lès-Tours, FranceDepartment of Infectious Diseases, Vinci Clinic, Alexandre Minkowski, Chambray-lès-Tours, FranceDepartment of Infectious Diseases, Bretonneau University Hospital, Tonnellé, Tours, FranceBackground Conventional imaging is useful to assess interbody fusion by showing complete trabecular bony bridging, but has a low positive predictive value for pseudarthrosis. Because alterations of bone metabolism may precede structural anatomical changes on computed tomography (CT), we aimed to investigate the ability of fluorine 18 sodium fluoride positron emission tomography/computed tomography (18F-NaF PET/CT) to identify pseudarthrosis after spinal fusion using surgical revision as the reference standard. Methods We retrospectively reviewed 18F-NaF PET/CT scans performed between February 2019 and September 2020 in patients experiencing pain after spinal fusion. We included the 18 patients who underwent revision surgery for suspicion of pseudarthrosis. Five consecutive patients who were clearly fused on CT served as the control group. Results In the revision surgery group (n=18), visual assessment by 18F-NaF PET/CT revealed that all 22 cages with an increased 18F-NaF uptake around intercorporal fusion material had mobility at revision surgery, whereas none of the fused patients (n=5) showed uptake around cage/intervertebral disk space. Among the 18 patients with presumed aseptic pseudarthrosis, intraoperative cultures revealed surgical site infection (SSI) caused by Cutibacterium acnes (C. acnes) in seven patients (38.9%). There was a statistically significant difference in standardized uptake values and uptake ratios between the revision surgery and control groups (p=5.3× 10−6 and p=0.0002, respectively). Conclusions 18F-NaF PET/CT imaging appeared as a useful tool to identify pseudarthrosis following spinal fusion. The unexpectedly high prevalence (38.9%) of SSI caused by C. acnes found in presumed aseptic patients supports the utility of intraoperative cultures in revision cases for pseudarthrosis, even without preoperative clinical suspicion of SSI.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1750400fluorine-18 sodium fluoridepositron emission tomography/computed tomographyspinal fusionpseudarthrosis cutibacterium acnes |
| spellingShingle | Yacine El Yaagoubi Jean-Edouard Loret Eric Lioret Clément Thomas Adrien Simonneau Laurent Vinikoff Caroline Prunier-Aesch Alain Chetanneau Laurent Philippe Maja Ogielska Louis Bernard 18F-NaF PET/CT in Presumed Aseptic Pseudarthrosis after Spinal Fusion: Correlation with Findings at Revision Surgery and Intraoperative Cultures World Journal of Nuclear Medicine fluorine-18 sodium fluoride positron emission tomography/computed tomography spinal fusion pseudarthrosis cutibacterium acnes |
| title | 18F-NaF PET/CT in Presumed Aseptic Pseudarthrosis after Spinal Fusion: Correlation with Findings at Revision Surgery and Intraoperative Cultures |
| title_full | 18F-NaF PET/CT in Presumed Aseptic Pseudarthrosis after Spinal Fusion: Correlation with Findings at Revision Surgery and Intraoperative Cultures |
| title_fullStr | 18F-NaF PET/CT in Presumed Aseptic Pseudarthrosis after Spinal Fusion: Correlation with Findings at Revision Surgery and Intraoperative Cultures |
| title_full_unstemmed | 18F-NaF PET/CT in Presumed Aseptic Pseudarthrosis after Spinal Fusion: Correlation with Findings at Revision Surgery and Intraoperative Cultures |
| title_short | 18F-NaF PET/CT in Presumed Aseptic Pseudarthrosis after Spinal Fusion: Correlation with Findings at Revision Surgery and Intraoperative Cultures |
| title_sort | 18f naf pet ct in presumed aseptic pseudarthrosis after spinal fusion correlation with findings at revision surgery and intraoperative cultures |
| topic | fluorine-18 sodium fluoride positron emission tomography/computed tomography spinal fusion pseudarthrosis cutibacterium acnes |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1750400 |
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