{'fraction_non_alphanumeric': 0.02937365010799136, 'fraction_numerical': 0.016414686825053995, 'mean_word_length': 4.79, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Is Obtaining a Computed Tomography Prior to Offering Anterior Cervical Disc Arthroplasty (ACDA) Necessary? The Results of Surgeons Predicting ACDA Candidacy From Magnetic Resonance Imagings and X-Rays Alone


 
 
 Moderate/severe cervical spondylosis, and the presence of ossification of the posterior longitudinal ligament (OPLL) are contraindications to anterior cervical disc arthroplasty (ACDA). Although computed tomography (CT) is the gold standard for identifying these conditions, some surgeons proceed with ACDA surgery with only an magnetic resonance imaging (MRI) and plain radiographs. We sought to determine if an X-ray and MRI alone were adequate for assessing bridging osteophytes and OPLL, when considering ACDA candidates.
 
 
 
 A total of 121 cervical levels in 86 consecutive anterior cervical surgery candidates were included. None had prior cervical surgery, all were being considered for ADCA prior to obtaining a CT scan, and all were being considered for 1 to 2 levels of pathology. A total of 10 spine surgeons rated X-rays and MRIs to determine if the patients were suitable candidates for ACDA. Analysis was performed using Fleiss’ Kappa and sensitivity and specificity.
 
 
 
 A total of 86 patients were included, CT scans changed the initial planned arthroplasty (ACDA) to fusion (ACDF) in 17% of cases (15 of 86) because of contraindications that included significant bridging osteophytes and/or OPLL. A total of 10 surgeons rated scans from 86 patients over 2 separate sessions using X-ray and MRIs. Intrarater reliability (k = 0.44), and inter-rater reliability (k = 0.24) demonstrated weak predictability in identifying which patients would be found on CT to have significant bridging osteophytes and/or OPLL. Raters were found to have diagnostic sensitivity and specificity of 69.59% and 52.51% respectively. An ACDA candidate was rated by a majority of surgeon raters for ACDA, although the CT scan found OPLL vs retrovertebral osteophyte, making this a contraindication to ACDA.
 
 
 
 CT scans changed operative management in 17% of ACDA-planned cases. Spine surgeon assessments of X-ray and MRIs alone for ACDA were highly unreliable with significantly weak intra-rater and inter-rater reliability, further emphasizing the need for obtaining CT scans on all ACDA candidates.
