In-hospital, postoperative radiographs after single-level spinal fusion may not be necessary

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A study published ahead of print in The Spine Journal has suggested that routine in-hospital postoperative radiographs after uneventful, single-level instrumented fusion do not add additional clinically relevant information to intraoperative fluoroscopy.

Robert Molinari, Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, USA, stated that for many surgeons, immediate postoperative imaging was a “standard of care” for spinal fusion patients. However, they wrote that while immediate postoperative radiographs may be valuable for patients with a complicated postoperative course after fusion surgery or those with traumatic spinal injuries or deformity, the value of radiographs after single-level degenerative fusion in uncomplicated patients is less clear. Molinari et al added: “Are postoperative standing radiographs necessary before hospital discharge in patients who have an uneventful postoperative course?”


The investigators conducted a retrospective review of 100 patients, over two-years, who had undergone uncomplicated single-level cervical or lumbar fusion surgery. In all patients, intraoperative fluoroscopic (both anteroposterior and lateral) imaging was used to document accurate implant placement during surgery and postoperative (performed within 72 hours of the operation) standing anteroposterior and lateral radiographs were also taken. Two orthopaedic surgeons then compared the intraoperative images with the postoperative images. 

Of the 100 patients, 26 had a radiograph image that was clinically malrotated and, therefore, could not be included in the comparison study. Molinari et al reported that previous studies have also demonstrated poor quality postoperative imaging.

In the remaining 74 patients, the authors wrote: “There was no significant difference noted by either observer between intraoperative and immediate postoperative interbody graft position. Additionally, no difference was demonstrated in spondylolisthesis grade between the intraoperative fluoroscopic image and postoperative images in all 49 patients who had preoperative degenerative or isthmic spondylolisthesis.”

According to the authors, their data demonstrated that “intraoperative fluoroscopic imaging provides an accurate initial baseline study for the documentation of implant position, segmental sagittal alignment, interbody graft position, and spondylolisthesis grade after single-level instrumentation for degenerative pathologies.” They added that, in their study, postoperative radiographs did not identify “additional clinically relevant information”.

 

Molinari told Spinal News International: “I think this study clearly demonstrates more consistent accuracy and a potential for significant cost savings with the use of intraoperative fluoroscopic imaging as the baseline study for instrumented single-level degenerative fusion procedures. The routine use of in-house postoperative radiographs does not appear to be of significant additional clinical benefit in patients who have an uncomplicated postoperative course.” He added that for patients who have undergone uneventful single-level spinal fusion, immediate postoperative radiographs after should no longer be routine practice.