Clinical Utility of Routine Postoperative Imaging in Spinal Fusion Surgery: A Systematic Review

Shost, Michael D.; Jella, Tarun K.; Ronald, Andrew A.; Herring, Eric; Sajatovic, Martha; Smith, Gabriel A.

doi:10.1016/j.wneu.2022.07.091

Cited by 1 publication

(1 citation statement)

References 27 publications

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“…Yamashita et al10 suggested limited benefit of routine PO radiographs citing only 1 of 111 visits resulting in abnormal findings. Shost et al11 analyzed 3155 PO visits and found 6.2% abnormal radiographs wherein only 0.5% resulted in altered management. The utility of long-term radiographic follow-up is also limited.…”

Section: Recommend Against Long-term Follow-up If Asymptomaticmentioning

confidence: 99%

Is Long-term Follow-up for Asymptomatic Patients After Lumbar Fusion Necessary?

Petrone

Caballero

et al. 2023

Clinical Spine Surgery: A Spine Publication

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For purposes of this discussion, we define "longterm" outpatient follow-up as scheduled office visits after 3 months or more postoperatively. "Asymptomatic/minimally symptomatic" is defined as having mild to no symptoms and being able to return to all desired activities. The rate of complex lumbar fusion procedures increased by 32% from 2004 to 2015. 1 As such, there has been a proportionate increase in postoperative (PO) follow-up visits. Currently, there is a dearth of evidence regarding the optimum timeline for how long a patient should be followed postoperatively from a lumbar spinal fusion. The addition of continued outpatient clinic appointments for up to 1-2 years is likely a result of spine surgeons adopting similar workflows derived from their training. We suggest ~3 months time after lumbar spinal fusion is sufficient follow-up for asymptomatic patients. This time point is suggested because this is when most restrictions have been lifted for minimally symptomatic patients, and they have returned to all activities and work if applicable. To avoid unnecessary utilization of time and resources, an endpoint should be identified wherein the maximum benefit is achieved including the identification of complications, and outcomes are not adversely affected.The majority of PO complications occur within 3 months of surgery. In a meta-analysis by Veeravagu et al, 2 the authors found the majority of infections, wound dehiscence, and other wound complications had the highest occurrence rate 10-20 days postoperatively. Mehrotra et al 3 concluded that lumbar fusions have a 1.54% rate of wound complications within the first 30 days and a 1.17% rate of reoperation within 90 days. Eliasberg et al 4 retrospectively reviewed over 50,000 lumbar fusions and found a 90-day reoperation rate of only 4%. Martin et al 5 analyzed 2345 lumbar fusion procedures to determine their reoperation rates and causes. They found an

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Section: Recommend Against Long-term Follow-up If Asymptomaticmentioning

confidence: 99%