Do We Need Standing Scoliosis Films for One or Two-Level Lumbar Fusions?

Abstract

Abstract INTRODUCTION As surgeons become more aware of deformity, some say that “you either treat deformity or you create it.” A common concern is that patients who undergo 1 or 2-level lumbar fusions for degenerative disease may need more extensive procedures due to undetected spinal misalignment. We prospectively evaluated our 1 or 2-level lumbar fusion candidates with standing scoliosis films to determine whether we needed to change our initial operative plan. METHODS All patients, offered a lumbar fusion, were recommended to undergo standing scoliosis films prior to surgery. The sagittal vertical alignment (SVA) and pelvic incidence (PI) minus lumbar lordosis (LL) were measured using free available software (Surgimap). RESULTS Between January 2015 and December 2018, 170 patients underwent a 1 or 2-level fusion at our institution, of which 127 accepted to undergo standing scoliosis films prior to surgery. The average SVA was 1.5 cm (range: −5 to 11 cm) and average PI-LL was 2.5 degrees (range: −5 to 11 degrees). The borderline patients were older and the parameters were considered acceptable for age. The original operative plan was not changed for any patient. CONCLUSION Standing scoliosis films are probably not necessary in patients who are candidates for a 1 or 2-level lumbar fusion for degenerative disease. This imaging is not available in most hospitals and incurs additional costs that should be reserved for patients needing multilevel fusions and/or clinical deformity correction