Clinical Utility of Routine Postoperative Imaging in Spinal Fusion Surgery: A Systematic Review.

Autor: Shost MD; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA., Jella TK; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA., Ronald AA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA., Herring EZ; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA. Electronic address: Eric.Herring2@uhhospitals.org., Sajatovic M; Department of Neurology and Psychiatry, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA., Smith GA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2022 Nov; Vol. 167, pp. 222-228.e1. Date of Electronic Publication: 2022 Jul 31.
DOI: 10.1016/j.wneu.2022.07.091
Abstrakt: Objective: Following spinal fusion surgery, routine imaging is often obtained in all patients regardless of clinical presentation. Such routine imaging may include x-ray, computed tomography, or magnetic resonance imaging studies in both the immediate postoperative period and after discharge. The clinical utility of this practice is questionable. Our goal is to assess the existing literature for evidence of impact on clinical care from routine radiographic surveillance following spinal fusion.
Methods: A systematic search of Embase, Scopus, PubMed, Cochrane, and Ovid databases was performed for studies investigating postoperative imaging following spinal fusion surgery. Studies were analyzed for imaging findings and rates of change in management due to imaging.
Results: In total, the review identified 9 studies that separated data by unique patient or by unique clinic visits. The 4 studies reporting per-patient data totaled 475 patients with 328 (69%) receiving routine imaging. Among these, 28 (8.5%) patients had abnormal routine findings with no patients having a change to their clinical course. Of the 5 studies that reported clinic visit data, 3119 patient visits were included with 2365 (76%) clinic visits accompanied by imaging. Across these 5 studies, 146 (6.2%) visits noted abnormal imaging with only 12 (0.5%) subsequent management changes.
Conclusions: Our analysis found that routine imaging after spinal fusion surgery had no direct benefit on clinical management. The utility of baseline imaging for long-term comparison and medicolegal concerns were not studied and remain up to the provider's judgment. Further research is necessary to identify optimal imaging criteria following spinal fusion surgery.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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