Plain Films

Plain X-rays allow the verification of laminectomy site(s) and placement of internal fixation devices (pedicle screws, hooks, plates, rods, bone cement, etc.). The placement may be graded as either appropriate and at the right level or inappropriate and/or at the wrong level. Plain X-rays may also allow evaluation of the general sagittal alignment of the spine and bone quality. They also enable the detection of breakage or loosening of the implants, pulling out of pedicle screws, and/or subsidence of intervertebral cages.

Plain films may also provide the means to evaluate bony fusion (posterior, interbody, or intertransverse fusion). The assessment of fusion quality is based on the appearance of bridging trabecular bone. It may be classified as fused (when no loss of continuity of the trabecu-lar bone is observed), not fused (when bone continuity is interrupted), or uncertain (when bone continuity across the operated segment is questionable). There may, however, be a high false positive rate (up to 42%) if one relies solely on X-rays to diagnose solid bony fusion.

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