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Tytuł pozycji:

Immediate Postoperative Imaging Following Elective Lumbar Fusion Provides Little Clinical Utility.

Tytuł:
Immediate Postoperative Imaging Following Elective Lumbar Fusion Provides Little Clinical Utility.
Autorzy:
Ronald AA; School of Medicine, Case Western Reserve University, Cleveland, OH.
Herring EZ; School of Medicine, Case Western Reserve University, Cleveland, OH.; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH.
Gerges C; School of Medicine, Case Western Reserve University, Cleveland, OH.
Shost M; School of Medicine, Case Western Reserve University, Cleveland, OH.
Jella T; School of Medicine, Case Western Reserve University, Cleveland, OH.
Sajatovic M; School of Medicine, Case Western Reserve University, Cleveland, OH.; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH.
Labak CM; School of Medicine, Case Western Reserve University, Cleveland, OH.; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH.
Smith G; School of Medicine, Case Western Reserve University, Cleveland, OH.; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH.
Źródło:
Spine [Spine (Phila Pa 1976)] 2021 Jul 15; Vol. 46 (14), pp. 958-964.
Typ publikacji:
Journal Article
Język:
English
Imprint Name(s):
Publication: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Hagerstown, Md., Medical Dept., Harper & Row.
MeSH Terms:
Lumbar Vertebrae*/diagnostic imaging
Lumbar Vertebrae*/surgery
Spinal Fusion*
Humans ; Postoperative Care ; Reoperation/statistics & numerical data ; Retrospective Studies ; Treatment Outcome
References:
Bohl DD, Ruiz FK, Webb ML, et al. Routine imaging for elective lumbar spine surgery. Spine (Phila Pa 1976) 2013; 38:1233–1237.
Molinari RW, Hunter JG, McAssey RW. In-hospital postoperative radiographs for instrumented single-level degenerative spinal fusions: utility after intraoperative fluoroscopy. Spine J 2012; 12:559–567.
Molinari RW, Molinari R, Mcassey RW. Post-operative radiographs for degenerative lumbar spinal fusions? J Spine 2015; S6:265 https://doi.org/10.4172/2165-7939.S6-004. (PMID: 10.4172/2165-7939.S6-004)
Martin BI, Mirza SK, Spina N, et al. Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. Spine (Phila Pa 1976) 2019; 44:369–376.
Papanicolas I, Woskie LR, Jha AK. Health care spending in the United States and other high-income countries. JAMA 2018; 319:1024–1039.
Smith-Bindman R, Miglioretti DL, Johnson E, et al. Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996–2010. JAMA 2012; 307:2400–2409.
Romero NC, Glaser J, Walton Z. Are routine radiographs needed in the first year after lumbar spinal fusions? Spine (Phila Pa 1976) 2009; 34:1578–1580.
Simpson AK, Osler P, Wood KB. Utility of postoperative radiographs after anterior lumbar interbody fusion with or without posterior instrumentation. Spine (Phila Pa 1976) 2013; 38:2038–2042.
Yamashita T, Steinmetz MP, Lieberman IH, et al. The utility of repeated postoperative radiographs after lumbar instrumented fusion for degenerative lumbar spine. Spine (Phila Pa 1976) 2011; 36:1955–1960.
Bohl DD, Telles CJ, Hustedt JW, et al. Postanesthesia care unit imaging is unnecessary when intraoperative imaging is used during anterior cervical decompression and fusion procedures. J Spinal Disord Tech 2012; 25:E174–E177.
Martin SC, Dabbous BO, Ridgeon EE, et al. Routine radiographs one day after anterior cervical discectomy and fusion are neither necessary nor cost-effective. Br J Neurosurg 2017; 31:50–53.
Chen DQ, Shimer AL, Li X, et al. Unplanned immediate return to operating room after spine surgery: significance of immediate postoperative radiographs. Spine (Phila Pa 1976) 2019; 44:258–262.
Bartels RHMA, Beems T, Schutte PJ, et al. The rationale of postoperative radiographs after cervical anterior discectomy with stand-alone cage for radicular pain: presented at the 2009 joint spine section meeting—clinical article. J Neurosurg Spine 2010; 12:275–279.
Shau DN, Bible JE, Samade R, et al. Utility of postoperative radiographs for cervical spine fusion: a comprehensive evaluation of operative technique, surgical indication, and duration since surgery. Spine (Phila Pa 1976) 2012; 37:1994–2000.
Derakhshan A, Lubelski D, Steinmetz MP, et al. Utility of computed tomography following anterior cervical diskectomy and fusion. Glob Spine J 2015; 5:411–416.
Grimm BD, Leas DP, Glaser JA. The utility of routine postoperative radiographs after cervical spine fusion. Spine J 2013; 13:764–769.
Entry Date(s):
Date Created: 20210125 Date Completed: 20210720 Latest Revision: 20231019
Update Code:
20240105
DOI:
10.1097/BRS.0000000000003953
PMID:
33492086
Czasopismo naukowe
Study Design: Retrospective review at a single institution of all adult patients who underwent elective lumbar fusion surgery for degenerative spinal disease from 2013 to 2018. Reoperation rates and change in clinical management due to routine imaging findings were the primary outcomes.
Objective: To investigate what effects immediate routine postoperative imaging has on the clinical management of patients following lumbar fusion surgery.
Summary of Background Data: The clinical utility of routine postoperative imaging following lumbar fusion surgery remains uncertain. Existing studies on the clinical utility of postoperative imaging in lumbar fusion patients have largely focused on imaging obtained post-discharge. We present a retrospective analysis that to our knowledge is the first study reporting on the clinical utility of routine imaging in lumbar fusion patients during the immediate postoperative period.
Methods: The medical records of patients who had undergone elective lumbar instrumented fusion for degenerative disease from 2013 to 2018 by neurosurgeons across one regional healthcare system were retrospectively analyzed. Inpatient records and imaging orders for patients were reviewed. Routine immediate postoperative imaging was defined by any lumbar spine imaging prior to discharge in the absence of specific indications.
Results: Analysis identified 115 patients who underwent elective lumbar instrumented fusion for degenerative disease. One-hundred-twelve patients received routine postoperative imaging. Routine imaging was abnormal in four patients (4%). There was one instance (<1%) where routine immediate postoperative imaging led to change in clinical management. Abnormal routine imaging was not associated with either reoperation or development of neurological symptoms postoperatively (P = 0.10), however, new or worsening neurologic deficits did predict reoperation (P < 0.01).
Conclusion: New neurologic deficit was the only significant predictor of reoperation. Routine imaging, whether normal or abnormal, was not found to be associated with reoperation. The practice of routine imaging prior to discharge following elective lumbar fusion surgery appears to provide little utility to clinical management.Level of Evidence: 3.
(Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

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