title: Routine radiographs one day after anterior cervical discectomy and fusion are neither necessary nor cost-effective.
abstract: OBJECTIVE
  Anterior cervical discectomy and fusion (ACDF) is a common operative treatment of compressive pathology of the cervical spinal cord, when caused by one or more degenerated intervertebral discs or related osteophytes. In addition to intra-operative radiographs to confirm spinal level before discectomy and implant position after insertion, traditional practice is to obtain post-operative antero-posterior and lateral plain radiographs (XR) before hospital discharge, despite a paucity of evidence supporting their benefit to patient care. Minimising unnecessary radiation to radiosensitive neck structures is desirable, and furthermore, with increasing financial pressure on healthcare resources, routine investigations should be clinically justified and evidence-based. We aim to compare the utility of routine post-operative cervical spine X-rays following ACDF.
  
  
  METHODS
  We compare two groups of consecutive patients undergoing ACDF in a single UK neurosurgical centre. The first group (n = 109) received routine post-operative XR imaging, and the second group (n = 113) received radiographs only when clinically indicated.
  
  
  RESULTS
  There were no differences in post-operative complication rates (4.6% vs. 5.3%), or requirement for further imaging or of further operative intervention (1.8% vs. 0.9%). The group that did not have routine post-operative radiographs had a significantly shorter stay in hospital (median two days vs. three days). There were no patients in either group where post-operative XR changed clinical management and mandated revision surgery or further imaging. All cases requiring surgery or further imaging were identified by clinical deterioration.
  
  
  CONCLUSIONS
  We suggest that the practice of obtaining routine radiographs of the cervical spine following ACDF should be abandoned, unless there is a clear clinical indication.
authors.affiliation: a Department of Neurological Surgery , Oxford University Hospitals , Oxford , UK.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Martin
authors.affiliation: a Department of Neurological Surgery , Oxford University Hospitals , Oxford , UK.
authors.forename: Bassam O
authors.initials: BO
authors.lastname: Dabbous
authors.affiliation: a Department of Neurological Surgery , Oxford University Hospitals , Oxford , UK.
authors.forename: Elliott E
authors.initials: EE
authors.lastname: Ridgeon
authors.affiliation: a Department of Neurological Surgery , Oxford University Hospitals , Oxford , UK.
authors.forename: Shailendra A
authors.initials: SA
authors.lastname: Magdum
authors.affiliation: a Department of Neurological Surgery , Oxford University Hospitals , Oxford , UK.
authors.forename: Thomas A D
authors.initials: TA
authors.lastname: Cadoux-Hudson
authors.affiliation: b Academic Neurosurgery Unit, St. George's , University of London , London , UK.
authors.forename: Erlick A C
authors.initials: EA
authors.lastname: Pereira
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D017586:Diskectomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000191:economics / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000191:economics* / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013131:Spine / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D006113:United Kingdom; D014965:X-Rays
keywords: Anterior cervical discectomy and fusion; complication; post-operative radiograph