Routine imaging for elective lumbar spine surgery

Abstract

Study Design. Cross-sectional, questionnaire study. Objective. To characterize imaging practices for 3 common lumbar spine procedures. Summary of Background Data. As lumbar surgical procedures are performed with increasing frequency, it becomes incrementally more important to optimize patient care, minimize risk, and reduce associated costs. Imaging is an area for potential improvement; however, little has been done to characterize current imaging practices, compare imaging practices with current evidence, or establish a standard of care. Methods. We distributed a single-page questionnaire to all attending spine surgeons at a United States spine conference (The Spine Study Group) in 2012. Results. Forty-one of 74 surgeons (55.4%) completed and returned the questionnaire. All results are given for posterior lumbar decompression, posterior lumbar fusion, and anterior lumbar fusion, respectively. Intraoperatively, 75%, 90%, and 95% of surgeons use fl uoroscopy, whereas 25%, 10%, and 5% use plain fi lm; 80%, 59%, and 54% take images prior to skin incision; 59%, 98%, and 100% always take fi nal images at the end of the procedure while still in the operating room. Postoperatively, 13%, 54%, and 54% of surgeons take images after patients have left the operating room but before they have been discharged. Interestingly, 10%, 50%, and 51% of surgeons not only take intraoperative images of their fi nal constructs, but also take additional images before discharge. Surgeons follow their postoperative outpatients with imaging for a mean of 0.4, 1.5, and 1.5 years. Fifty-four percent, 98%, and 100% follow with anterior-posterior views; 56%, 93%, and 95% with lateral views; and 15%, 39%, and 39% with fl exion-extension fi lms. For both anterior and posterior fusion, 26% routinely follow with computed tomographic scan to assess fusion. Conclusion. Findings highlight extreme variability in practice associated with a notable lack of standard of care and provide a baseline for utility studies that may lead to more evidence-driven care. Copyright © 2013 Lippincott Williams & Wilkins.