STUDY DESIGN: Retrospective case series. OBJECTIVE: To characterize the clinical utility of imaging in the recovery room after lumbar fusion procedures. SUMMARY OF BACKGROUND DATA: Two sets of images are commonly obtained at the end of lumbar fusion procedures: intraoperative fluoroscopic images near the time of wound closure and plain film images after the procedure in the recovery room. The latter may have low clinical utility. METHODS: We identified a consecutive series of lumbar fusion procedures. A panel of 3 reviewers assessed intraoperative and recovery room series both for radiographical adequacy and for issues with the surgical construct. RESULTS: One hundred ninety cases were reviewed, of which 92 were posterolateral lumbar fusions, 42 were anterior lumbar interbody fusions, 24 were transforaminal lumbar interbody fusions, and 32 were anterior-posterior fusions. All intraoperative series were adequate, whereas only 90% of recovery room series were adequate. Recovery room series had visible issues with construct placement in 4 cases. In each of these cases, however, the issue was also clearly visible on the intraoperative series, was found to be acceptable clinically, and did not alter management in any way. CONCLUSION: This study demonstrates that recovery room images are inferior to intraoperative images and offer little or no incremental clinical utility for detecting issues with surgical constructs after lumbar fusion procedures. In settings where it is still performed, recovery room imaging might be discontinued to realize savings in cost, radiation exposure, and time. LEVEL OF EVIDENCE: 4.
STUDY DESIGN: Retrospective case series. OBJECTIVE: To characterize the clinical utility of imaging in the recovery room after lumbar fusion procedures. SUMMARY OF BACKGROUND DATA: Two sets of images are commonly obtained at the end of lumbar fusion procedures: intraoperative fluoroscopic images near the time of wound closure and plain film images after the procedure in the recovery room. The latter may have low clinical utility. METHODS: We identified a consecutive series of lumbar fusion procedures. A panel of 3 reviewers assessed intraoperative and recovery room series both for radiographical adequacy and for issues with the surgical construct. RESULTS: One hundred ninety cases were reviewed, of which 92 were posterolateral lumbar fusions, 42 were anterior lumbar interbody fusions, 24 were transforaminal lumbar interbody fusions, and 32 were anterior-posterior fusions. All intraoperative series were adequate, whereas only 90% of recovery room series were adequate. Recovery room series had visible issues with construct placement in 4 cases. In each of these cases, however, the issue was also clearly visible on the intraoperative series, was found to be acceptable clinically, and did not alter management in any way. CONCLUSION: This study demonstrates that recovery room images are inferior to intraoperative images and offer little or no incremental clinical utility for detecting issues with surgical constructs after lumbar fusion procedures. In settings where it is still performed, recovery room imaging might be discontinued to realize savings in cost, radiation exposure, and time. LEVEL OF EVIDENCE: 4.
Authors: N L Weil; M El Moumni; S M Rubinstein; P Krijnen; M F Termaat; I B Schipper Journal: Arch Orthop Trauma Surg Date: 2017-07-22 Impact factor: 3.067