title: Do routine radiographs within the first two years following pediatric posterior spinal fusion prompt revision surgery?
abstract: METHODS
  This is a retrospective review of 265 consecutive patients with scoliosis treated by posterior spinal fusion (PSF) and 2990 postoperative radiographs at a single institution.
  
  
  OBJECTIVE
  To document implant-related complications on postoperative radiographs within the first 2 years after PSF and determine if these led to additional surgical procedures.
  
  
  BACKGROUND
  To date, there is an absence of studies investing the utility of radiographs after pediatric PSF surgery.
  
  
  METHODS
  The patient's average age was 14.9 years (8.2-21.8 yr). Positive radiographical findings included implant loosening, fracture, migration, or loss of fixation. We also noted which patients' required additional surgery for a radiographical finding and/or clinical finding (neurological deficit, intractable back pain, fever, and elevated erythrocyte sedimentation rate, c-reactive protein, or while blood cell count).
  
  
  RESULTS
  At an average follow-up of 16.3 months (12-24), only 18 (0.60%) radiographs demonstrated a positive finding. Of these, only 5 (0.17%) radiographs (along with clinical presentation) prompted revision. No patient returned to the operating room purely from a radiographical finding. The remaining 13 (0.37%) abnormal plain images were not associated with a clinical abnormality and were managed nonoperatively. The timing of the second operation was in the range from 1 day to 23 months (average, 11 mo). Postoperative plain radiographs had a sensitivity of 26.5%, a specificity of 99.5%, and a positive predictive value of 25%.
  
  
  CONCLUSIONS
  Only 0.60% of postoperative images (18/2990) demonstrated an implant-related complication, and in the absence of clinical indications, none of these patients required surgical intervention. Isolated postoperative radiographs did not lead to any change in management, and consideration should be given to reviewing current protocols for plain radiographs as a monitoring tool after PSF.
authors.affiliation: *The Hospital for Special Surgery, New York, NY †Hospital of the University of Pennsylvania, Philadelphia, PA; and ‡The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Grant H
authors.initials: GH
authors.lastname: Garcia
authors.forename: Min Jung
authors.initials: MJ
authors.lastname: Park
authors.forename: Keith
authors.initials: K
authors.lastname: Baldwin
authors.forename: John
authors.initials: J
authors.lastname: Flynn
authors.forename: David A
authors.initials: DA
authors.lastname: Spiegel
mesh_terms: D000293:Adolescent; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult