Subaraman Ramchandran1, Justin S Smith, Tamir Ailon, Eric Klineberg, Christopher Shaffrey, Virginie Lafage, Frank Schwab, Shay Bess, Alan Daniels, Justin K Scheer, Themi S Protopsaltis, Paul Arnold, Regis W Haid, Jens Chapman, Michael G Fehlings, Christopher P Ames. 1. *Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia;‡Department of Orthopaedic Surgery, University of California Davis Sacramento, California;§Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York;¶Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado;‖Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island;#Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois;**Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas;‡‡Department of Neurosurgery, Atlanta Brain and Spine Care, Atlanta, Georgia;§§Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington;¶¶Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada;‖‖Department of Neurosurgery, University of California San Francisco, San Francisco, California.
Abstract
BACKGROUND: Understanding the role of regional segments of the spine in maintaining global balance has garnered significant attention recently. Long-cassette radiographs (LCR) are necessary to evaluate global spinopelvic alignment. However, it is unclear how LCRs impact operative decision-making for cervical spine pathology. OBJECTIVE: To evaluate whether the addition of LCRs results in changes to respondents' operative plans compared to standard imaging of the involved cervical spine in an international survey of spine surgeons. METHODS: Fifteen cases (5 control cases with normal and 10 test cases with abnormal global alignment) of cervical pathology were presented online with a vignette and cervical imaging. Surgeons were asked to select a surgical plan from 6 options, ranging from the least (1 point) to most (6 points) extensive. Cases were then reordered and presented again with LCRs and the same surgical plan question. RESULTS: One hundred fifty-seven surgeons completed the survey, of which 79% were spine fellowship trained. The mean response scores for surgical plan increased from 3.28 to 4.0 (P = .003) for test cases with the addition of LCRs. However, no significant changes (P = .10) were identified for the control cases. In 4 of the test cases with significant mid thoracic kyphosis, 29% of participants opted for the more extensive surgical options of extension to the mid and lower thoracic spine when they were provided with cervical imaging only, which significantly increased to 58.3% upon addition of LCRs. CONCLUSION: In planning for cervical spine surgery, surgeons should maintain a low threshold for obtaining LCRs to assess global spinopelvic alignment.
BACKGROUND: Understanding the role of regional segments of the spine in maintaining global balance has garnered significant attention recently. Long-cassette radiographs (LCR) are necessary to evaluate global spinopelvic alignment. However, it is unclear how LCRs impact operative decision-making for cervical spine pathology. OBJECTIVE: To evaluate whether the addition of LCRs results in changes to respondents' operative plans compared to standard imaging of the involved cervical spine in an international survey of spine surgeons. METHODS: Fifteen cases (5 control cases with normal and 10 test cases with abnormal global alignment) of cervical pathology were presented online with a vignette and cervical imaging. Surgeons were asked to select a surgical plan from 6 options, ranging from the least (1 point) to most (6 points) extensive. Cases were then reordered and presented again with LCRs and the same surgical plan question. RESULTS: One hundred fifty-seven surgeons completed the survey, of which 79% were spine fellowship trained. The mean response scores for surgical plan increased from 3.28 to 4.0 (P = .003) for test cases with the addition of LCRs. However, no significant changes (P = .10) were identified for the control cases. In 4 of the test cases with significant mid thoracic kyphosis, 29% of participants opted for the more extensive surgical options of extension to the mid and lower thoracic spine when they were provided with cervical imaging only, which significantly increased to 58.3% upon addition of LCRs. CONCLUSION: In planning for cervical spine surgery, surgeons should maintain a low threshold for obtaining LCRs to assess global spinopelvic alignment.
Authors: Valérie N E Schuermans; Anouk Y J M Smeets; Toon F M Boselie; Math J J M Candel; Inez Curfs; Silvia M A A Evers; Henk Van Santbrink Journal: Trials Date: 2022-08-26 Impact factor: 2.728