title: Utility of postoperative radiographs for cervical spine fusion: a comprehensive evaluation of operative technique, surgical indication, and duration since surgery.
abstract: METHODS
  A retrospective study.
  
  
  OBJECTIVE
  To assess the utility of postoperative radiographs in patients across a spectrum of cervical fusion procedures, surgical indication, and time since surgery.
  
  
  BACKGROUND
  Postoperative radiographs are routinely obtained after cervical spine fusion despite lack of evidence supporting such practice. Studies assessing postoperative radiographical utility in the cervical spine have been limited. To date, no study has comprehensively evaluated the utility of obtaining such radiographs across multiple cervical fusion procedures.
  
  
  METHODS
  A total of 972 clinic notes from 301 patients during a 10-year period at a single institution were retrospectively reviewed. Patients in this study underwent an anterior cervical discectomy and fusion, anterior corpectomy and fusion, a combined anterior cervical discectomy and fusion and anterior corpectomy and fusion (hybrid), posterior spine fusion, or 360° fusion. All postoperative clinic notes and radiographs were reviewed for abnormalities and changes in treatment course. It was determined whether an abnormal radiograph alone led to a change in treatment course among the various operative techniques, surgical indication, or time since surgery.
  
  
  RESULTS
  No statistical significant difference in radiograph utility between anterior cervical discectomy and fusion (0 changes in treatment course due to radiograph alone out of 332 clinic notes), anterior corpectomy and fusion (0 of 140), hybrid procedure (1 of 72), posterior spine fusion (5 of 357), and 360° fusion (0 of 71) was found. Surgical indication (trauma vs. degeneration) and duration from surgery yielded no statistical significant difference in radiograph utility. The overall sensitivity, specificity, and positive and negative predictive values of radiographs were 33.8%, 87.6%, 19.0%, and 93.9%, respectively.
  
  
  CONCLUSIONS
  Regardless of operative techniques performed, surgical indication, and time since surgery, routine postoperative radiographs provide low utility in guiding treatment course in asymptomatic patients. Although radiographs may provide important diagnostic utility in certain individual cases, the results of this study provide further evidence that radiographs should not be considered routine during postoperative visits, thus minimizing unnecessary radiation exposure and medical costs.
authors.affiliation: Department of Orthopedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave. South, Nashville, TN 37232, USA.
authors.forename: David N
authors.initials: DN
authors.lastname: Shau
authors.forename: Jesse E
authors.initials: JE
authors.lastname: Bible
authors.forename: Richard
authors.initials: R
authors.lastname: Samade
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Gadomski
authors.forename: Bushra
authors.initials: B
authors.lastname: Mushtaq
authors.forename: Ato
authors.initials: A
authors.lastname: Wallace
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Kevin R
authors.initials: KR
authors.lastname: O'Neill
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D017586:Diskectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011859:Radiography; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome