title: Routine imaging for elective lumbar spine surgery: a questionnaire study.
abstract: METHODS
  Cross-sectional, questionnaire study.
  
  
  OBJECTIVE
  To characterize imaging practices for 3 common lumbar spine procedures.
  
  
  BACKGROUND
  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 fluoroscopy, whereas 25%, 10%, and 5% use plain film; 80%, 59%, and 54% take images prior to skin incision; 59%, 98%, and 100% always take final 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 final 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 flexion-extension films. For both anterior and posterior fusion, 26% routinely follow with computed tomographic scan to assess fusion.
  
  
  CONCLUSIONS
  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.
authors: Yale School of Medicine, New Haven, CT 06510, USA.
authors: Daniel D
authors: DD
authors: Bohl
authors: Ferrin K
authors: FK
authors: Ruiz
authors: Matthew L
authors: ML
authors: Webb
authors: Jordan A
authors: JA
authors: Gruskay
authors: Jonathan N
authors: JN
authors: Grauer
mesh_terms: D003430:Cross-Sectional Studies; D019299:Decompression, Surgical / Q000379:methods*; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D007432:Intraoperative Period; D008159:Lumbar Vertebrae / Q000601:surgery*; D011184:Postoperative Period; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D013123:Spinal Fusion / Q000379:methods*; D011795:Surveys and Questionnaires