The Value of Routine Postoperative Radiographs after Elective Lumbar Spinal Fusion Surgery

Abstract

Introduction Both intra- and postoperative radiographs are traditionally obtained after instrumented lumbar spinal surgery; however, the clinical advantage of routine postoperative images has not been demonstrated. The aim of this study is to explore the usefulness of routine predischarge postoperative radiographs in patients undergoing instrumented spinal surgery. Patients and Methods Patients ( n = 124) who underwent a lumbar spinal fusion were identified from a retrospective database, 58 patients were excluded. Unaltered intraoperative and predischarge postoperative PACS images for 66 patients were reviewed and were scored for the following: (1) Quality (0 = nondiagnostic, 1 = suboptimal, 2 = diagnostic, and 3 = good quality), (2) Focus (number of vertebra and disc seen), (3) Centering using a numbered [1–9] grid system, and (4) Rotation. Results A total of 66 radiographs were analyzed for the following: (1) Quality: 60 AP and 56 lateral intraoperative images whereas 57 AP and 39 lateral postoperative images were diagnostic; (2) Focus: average number of unnecessary vertebra seen in intraoperative AP and lateral images were 0.89 and 1.09, whereas on postoperative AP and lateral images were 8.05 and 6.45, respectively; (3) Centering: 48 AP and 51 lateral intraoperative images, whereas 27 AP and 20 lateral postoperative images were adequately centered; and (4) Rotation was adequate in both intraoperative and postoperative images. Conclusion Intraoperative images scored higher in all parameters suggesting that routine postoperative prehospital discharge radiographs are unnecessary unless specifically indicated and this practice should be discontinued with benefits including reduction of radiation dose (and subsequent sequelae), fiscal burden, and length of stay.