Superiority of Multidetector Computed Tomography with 3-Dimensional Volume Rendering over Plain Radiography in the Assessment of Spinal Surgical Instrumentation Complications in Patients with Cancer

Objective The objective of this study was to compare multidetector computed tomography (MDCT) images with volume-rendered translucent display (VRTLD) series to plain radiographs for evaluating spinal surgical instrumentation after resection and reconstruction for spinal malignancies. Methods In 44 patients with tumor resection and spinal reconstruction, 17 with complications, 3 neuroradiologists evaluated plain radiographs, MDCT images alone, VRTLD images alone, and MDCT images with VRTLD images for identifying complications in 3 categories: subsidence/migration, construct fracture, and screw loosening. Each category was scored as 1 (complications), 2 (no complications), or 3 (not sure), and the minimum score was used for analyses. Clinical/surgical outcomes were the reference standard. Results Sensitivity, specificity, and accuracy (95% confidence interval), respectively, were as follows: MDCT/VRTLD, 100%, 100%, 100% (91.96%-100.00%); MDCT alone, 88.24%, 100%, 95.45% (84.53%-99.44%); VRTLD alone, 82.35%, 96.3%, 90.91% (78.33%-97.47%); plain radiographs, 52.94%, 100%, 81.82% (67.29%-91.81%). Conclusions Multidetector computed tomography with VRTLD series seems best for evaluation of spinal instrumentation after tumor resection and reconstruction.