Updated imaging does not affect revision rates in adults undergoing spine surgery for lumbar degenerative disease

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Diagnostic workup for lumbar degenerative disc disease (DDD) includes imaging such as radiography, MRI, and/or CT myelography. If a patient has unsuccessful nonoperative treatment, the surgeon must then decide if obtaining updated images prior to surgery is warranted. The purpose of this study was to investigate whether the timing of preoperative neuroimaging altered clinical outcome, as reflected by the subsequent rate of revision surgery, in patients with degenerative lumbar spinal pathology.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>From the Health Care Service Corporation administrative claims database, adult patients (minimum age 55 years old) with lumbar DDD who underwent surgery including posterior lumbar decompression with and without fusion (1–2 levels) and at least 5 years of continuous coverage after the index surgery were identified. The chi-square test was used to determine differences in revision rates stratified by timing of each imaging procedure relative to the index procedure (&lt; 6 months, 6–12 months, 12–24 months, or &gt; 24 months).</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Of 28,676 cases identified, 5128 (18%) had revision surgery within 5 years. The timing of preoperative MRI or plain radiography was not associated with revision surgery. Among the entire cohort, there was a lower incidence of revision surgery in patients who had a CT myelogram within 1 year prior to the index surgery (p = 0.017). This observation was strongest in patients undergoing decompression only (p = 0.002), but not significant in patients undergoing fusion (p = 0.845).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Routine reimaging prior to surgery, simply because the existing MRI is 6–12 months old, may not be beneficial, at least as reflected in subsequent revision rates. The study also suggests that there may be a subset of patients for whom preoperative CT myelography reduces revision rates. This topic has important financial implications and deserves further study in a more granular data set.</jats:p></jats:sec>

Preliminary Evaluation of Standing Full-Length Plain Radiographs Utility in an Adult Degenerative Spine Practice

“…Patients reviewed during the survey had a mean age of 56.5 6 11.7 years and an average body mass index of 28.8 6 5.35 kg/m 2 . Of the 30-patient cohort, 56.7% (17) were women. The two most common patient co-morbidities were hypertension (34.6%, n = 9) and sleep apnea (15.4%, n = 4), and a tie for third most common comorbidity was observed between diabetes mellitus (7.7%, n = 2), coronary artery disease (7.7%, n = 2), and atrial fibrillation (7.7%, n = 2).…”

“…Although the FLSR is a single element in the broad presurgical picture, it is, nonetheless, a necessary component of evaluation. 1 Although still somewhat controversial, 17 the use of preoperative FLSR in patients with lumbar degenerative spinal stenosis is associated with fewer subsequent revision procedures, when compared with MRI or CT myelogram. 16 When considering this along with our observation that FLSRs can reduce the variation of surgical plans, this study demonstrated the need to investigate further the ability of FLSRs to decrease costs and to reduce patient morbidity and mortality.…”

Bacteria in Surgical Smoke: A Self-controlled Laboratory Study Using Porcine Spinal Tissues

“…The authors concluded that occult bacteria can be “ present in tissues deep below the skin before surgery ” in patients undergoing primary spine surgeries 9 . Revision spine surgery, which has a 5-year incidence of 10% to 18% 22 in degenerative lumbar spinal disorder and 6% to 20% 23 in adult spinal deformity, has also been found to often carry subclinical infections 24 . In a retrospective review of 595 revision spine surgeries performed for indications other than infection, operative cultures were obtained in 19% (112) of the cases, 40% (45) of whom tested positive 24 .…”