Wednesday, September 26, 2018 10:35 AM – 12:00 PM Cervical Spine Trauma: 27. The utility of in-hospital postoperative radiographs following surgical treatment of traumatic cervical spine injuries

Abstract

BACKGROUND CONTEXT Postoperative radiographs are routinely obtained following the surgical treatment of traumatic cervical spine injuries. Previous studies have evaluated the utility of postoperative radiographs following elective cervical spine surgery for degenerative conditions, but there has been no study evaluating this exclusively in the trauma population. This routine imaging comes at a financial cost to the health care system in addition to exposing the patient to an increased radiation dose. We hypothesized that routine postoperative X-ray imaging following surgical treatment of cervical spine traumatic injuries are unwarranted in the absence of changes in clinical findings. PURPOSE To assess the utility of routine in-hospital postoperative radiographs following surgical treatment of traumatic cervical spine injuries. STUDY DESIGN/SETTING Retrospective study. PATIENT SAMPLE All patients who underwent surgical treatment of traumatic cervical spine injuries over an eight-year period between January 2008 and December 2016 at a Level I trauma center. OUTCOME MEASURES Requirement of revision surgery. METHODS A retrospective chart review of the patients who underwent surgical treatment of traumatic cervical spine injuries over an eight-year period between January 2008 and December 2016 at a Level I trauma center was performed. Prior to discharge, postoperative upright AP and lateral radiographs were obtained and reviewed by one of the surgeons as per standard protocol. Those patients who subsequently required revision surgery were identified and further analyzed to identify if the results of the radiographs obtained led to the subsequent intervention or if other indications for surgery were present. RESULTS A total of 295 patients (177 males and 118 females) were identified with a mean age of 57.4 years (range, 18-94) between January 2008 and December 2016 with mean follow up of 284 days. All had routine postoperative upright X-ray imaging as well as during follow-up visits. There were two occipito-cervical fusions, 128 C1-2 posterior spinal fusions (PSFs), 50 subaxial cervical PSFs, seven odontoid screws, 81 anterior cervical discectomy and fusions (ACDFs), four anterior cervical corpectomy and fusions (ACCFs) and eight 360° fusions. Ten patients required subsequent surgeries: five for wound complications, two for neurological decline requiring decompression, one for recurrent subluxation, and two for non-union or mal-union. Four other patients were noted to have broken/loose hardware that were managed conservatively. Advanced imaging (CT/MRI) was ordered in 13 patients, nine of which required additional surgery: In the cases requiring additional surgery, the postoperative radiographs added no value in guiding treatment in the absence of clinical findings. Every patient who underwent additional surgery had clinical findings (ie, wound breakdown, new-onset radiculopathy or continued pain) that were of concern. Cervical radiographs alone added an additional $545,868 of health care cost during the study period. CONCLUSIONS Routine in-hospital and postoperative radiographs following surgical treatment of traumatic cervical spine injuries are of little value, especially in the absence of changes in examination or symptoms. In our experience, only 2.3% (7/295) patients had hardware-related complications, four of which were asymptomatic and three of which required subsequent surgery. With today's increasing emphasis on cost efficiency and evidence-based practice, we recommend against obtaining routine postoperative imaging in the absence of new clinical findings. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.