Routine Imaging for Elective Lumbar Spine Surgery

Bohl, Daniel D.; Ruiz, Ferrin K.; Webb, Matthew L.; Gruskay, Jordan A.; Grauer, Jonathan N.

doi:10.1097/brs.0b013e31828cb001

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…However, prior, similar studies have not shown any association between geographic location and imaging practices. 8,9 Another limitation is that this data, which was based on self-report, may not be as reliable as data collected directly from a large series of hospital systems or physician groups or data extracted from a review of a series of surgeons' records. Because these data are based on self-report, there is the significant potential that errors in surgeons' memories and estimations could have biased results.…”

Section: Discussionmentioning

confidence: 99%

Routine Imaging after Operatively Repaired Distal Radius and Scaphoid Fractures: A Survey of Hand Surgeons

et al. 2014

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).Imaging contributes substantially to the rising cost of health care. 1 Among surgical specialists, orthopaedic surgeons order a particularly high volume of imaging. Radiographic series are regularly taken during the initial evaluation of a patient, during preoperative planning, while the operation is under way, immediately after the operation, and at intervals throughout postoperative follow-up. In addition to the financial burden, imaging is associated with patient and staff time and exposure to radiation. AbstractBackground There is currently no standard of care for imaging after hand and upperextremity procedures, and current imaging practices have not been characterized. Questions/Purposes To characterize current imaging practices and to compare those practices to the best available evidence.Patients and Methods A survey was distributed to attending-level surgeons at a regional hand and upper-extremity surgery conference in the United States in 2013. 40 out of 75 surgeons completed the survey (53%).Results All results are presented for distal radius and scaphoid fractures, respectively. There was a high degree of variability between respondents in the number of radiographic series routinely ordered during follow-up of asymptomatic patients, with the number of series ranging from 1-6 and 1-6. On average, respondents did not order an excessive number of follow-up radiographs for asymptomatic patients, with means (AE standard deviations) of 2.6 AE 1.0 and 3.3 AE 1.2 radiographic series. Radiographic series were taken at only 74% and 81% of postoperative visits with asymptomatic patients. Only 10% and 8% of respondents felt it was acceptable medical practice to save costs by ordering postoperative radiographs only when patients are symptomatic.Conclusions Among a sample of 40 fellowship-trained hand surgeons, these findings demonstrate a high degree of variability in number of radiographs obtained after operative repair of distal radius and scaphoid fractures. On average, respondents were relatively efficient with respect to total number of postoperative radiographs ordered. Level of Evidence Diagnostic study, level IV.

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Section: Discussionmentioning

confidence: 99%

Routine Imaging after Operatively Repaired Distal Radius and Scaphoid Fractures: A Survey of Hand Surgeons

et al. 2014

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“…The benefit of obtaining radiographic images past the index operation during postoperative hospital stay remains contentious among surgeons. In a survey of spine surgeons, 54% indicated they order postoperative imaging after surgery before discharge 1 . Furthermore, the majority ordered routine postoperative imaging even with adequate intraoperative images of the patient's final construct 1 .…”

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confidence: 99%

“…In a survey of spine surgeons, 54% indicated they order postoperative imaging after surgery before discharge 1 . Furthermore, the majority ordered routine postoperative imaging even with adequate intraoperative images of the patient's final construct 1 . Evidence suggests there is no detectable movement of implanted hardware in the immediate postoperative period, 2,3 raising doubts on the utility of immediate postoperative imaging, especially in the setting of adequate intraoperative films of the hardware.…”

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confidence: 99%

Immediate Postoperative Imaging Following Elective Lumbar Fusion Provides Little Clinical Utility

Ronald

Herring

Gerges

et al. 2021

Spine

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Study Design. Retrospective review at a single institution of all adult patients who underwent elective lumbar fusion surgery for degenerative spinal disease from 2013 to 2018. Reoperation rates and change in clinical management due to routine imaging findings were the primary outcomes. Objective. To investigate what effects immediate routine postoperative imaging has on the clinical management of patients following lumbar fusion surgery. Summary of Background Data. The clinical utility of routine postoperative imaging following lumbar fusion surgery remains uncertain. Existing studies on the clinical utility of postoperative imaging in lumbar fusion patients have largely focused on imaging obtained post-discharge. We present a retrospective analysis that to our knowledge is the first study reporting on the clinical utility of routine imaging in lumbar fusion patients during the immediate postoperative period. Methods. The medical records of patients who had undergone elective lumbar instrumented fusion for degenerative disease from 2013 to 2018 by neurosurgeons across one regional healthcare system were retrospectively analyzed. Inpatient records and imaging orders for patients were reviewed. Routine immediate postoperative imaging was defined by any lumbar spine imaging prior to discharge in the absence of specific indications. Results. Analysis identified 115 patients who underwent elective lumbar instrumented fusion for degenerative disease. One-hundred-twelve patients received routine postoperative imaging. Routine imaging was abnormal in four patients (4%). There was one instance (<1%) where routine immediate postoperative imaging led to change in clinical management. Abnormal routine imaging was not associated with either reoperation or development of neurological symptoms postoperatively (P = 0.10), however, new or worsening neurologic deficits did predict reoperation (P < 0.01). Conclusion. New neurologic deficit was the only significant predictor of reoperation. Routine imaging, whether normal or abnormal, was not found to be associated with reoperation. The practice of routine imaging prior to discharge following elective lumbar fusion surgery appears to provide little utility to clinical management. Level of Evidence: 3

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

Shost¹,

Jella²,

Ronald³

et al. 2022

World Neurosurgery

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Routine Imaging for Elective Lumbar Spine Surgery

Abstract: Findings highlight extreme variability in practice associated with a notable lack of standard of care and provide a baseline for utility studies that may lead to more evidence-driven care.

Cited by 5 publications

References 5 publications

Routine Imaging after Operatively Repaired Distal Radius and Scaphoid Fractures: A Survey of Hand Surgeons

Routine Imaging after Operatively Repaired Distal Radius and Scaphoid Fractures: A Survey of Hand Surgeons

Immediate Postoperative Imaging Following Elective Lumbar Fusion Provides Little Clinical Utility

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

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