Radiography unnecessary after spinal fusion surgery

In an effort to determine the additional clinical yield and cost-effectiveness of in-hospital postoperative standing radiographs, Robert W. Molinari, M.D., from the University of Rochester Medical Center in New York, and colleagues reviewed 100 consecutive degenerative spinal surgery patients who had undergone instrumented single-level spinal fusions with intraoperative fluoroscopic guidance. All patients had an uneventful postoperative hospitalization.

The researchers found no cases of early instrumentation failure or screw position change. Based on anteroposterior and lateral radiographs, 74 patients had a grid match for all screw tip positions. However, 26 patients had radiographs that were clinically malrotated and could not be compared with intraoperative true fluoroscopic images. Segmental sagittal alignments from intraoperative fluoroscopic and postoperative radiographs were similar (average difference, 1.2 degrees), as were intraoperative and immediate postoperative interbody graft position and spondylolisthesis grade. Patient hospital billing charges averaged $600 for postoperative radiographs and interpretation.

"In patients who have a single-level instrumented fusion and a documented uneventful postoperative course, in-hospital postoperative standing anteroposterior and lateral radiographs do not appear to provide additional clinically relevant information when intraoperative fluoroscopy is properly used," Molinari and colleagues conclude.

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Journal reference: Spine Journal

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