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The Utility of In-Hospital Postoperative Radiographs Following Surgical Treatment of Traumatic Thoracolumbar Injuries

Pyun, Joseph, MD; Camacho, Jael E., MD; Usmani, M. Farooq, MSc; Weir, Tristan B., MD; Yousaf, Omer, MD; Sood, Ashum, BS; Vishwanath, Vijay, BA; Jolissaint, Josef, BS; Shasti, Mark, MD; Koh, Eugene Y., MD, PhD; Banagan, Kelley E., MD; Gelb, Daniel E., MD; Ludwig, Steven C., MD

doi: 10.1097/BSD.0000000000000826
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Study Design: A retrospective cohort study.

Objective: The objective of this study was to assess the utility of routine in-hospital postoperative radiographs for identifying hardware failure following surgical treatment of traumatic thoracolumbar (TL) injuries.

Background: Postoperative radiographs following spine surgery are considered standard of care despite a lack of evidence supporting their utility. Previous studies have concluded that postoperative radiographs following lumbar fusion for degenerative conditions have limited clinical value.

Materials and Methods: A retrospective chart review was performed on patients who underwent surgical treatment of traumatic TL injuries between December 2006 and October 2015 at a level I trauma center. Before discharge, postoperative upright anteroposterior and lateral radiographs were obtained and reviewed by 1 surgeon and 1 radiologist as per protocol. Patients who subsequently underwent revision surgery during their initial hospital stay were identified. These patients were further analyzed to identify the indications for surgery and determine if the results of the radiographs obtained led to the subsequent revision surgery.

Results: A total of 463 patients were identified who underwent surgical treatment following TL trauma. The rate of revision surgery during the initial hospitalization was 1.3% (6/463). Three patients underwent revision surgery due to worsening neurological status. One patient underwent reoperation because of advance imaging obtained for abdominal trauma. Two patients underwent revision surgery due to abnormal findings on postoperative radiographs. The overall sensitivity and specificity of routine postoperative radiographs was 33.3% and 100%, respectively.

Conclusions: In the absence of new clinical signs and symptoms, obtaining routine in-hospital postoperative radiographs following surgical treatment of TL injuries provides minimal value. Clinical assessment should help determine if additional imaging is indicated for the patient. Avoiding unnecessary inpatient tests such as routine postoperative radiograph may offer multitude of benefits including lowering patient radiation exposure, reducing health care costs and better allocation of hospital resources.

Level of Evidence: Level III.

Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, MD

D.E.G.: Advanced Spinal Intellectual Property: stock or stock options; AOSpine North America: board or committee member; Depuy-Synthes Spine: IP royalties; paid presenter or speaker; Globus Medical: IP royalties. S.C.L.: American Board of Orthopaedic Surgery Inc.: board or committee member; American Orthopaedic Association: board or committee member; AOSpine North America Spine Fellowship Support: research support; ASIP, ISD: stock or stock options; Cervical Spine Research Society: board or committee member; DePuy, A Johnson & Johnson Company: IP royalties; paid consultant; paid presenter or speaker; Globus Medical: paid consultant; research support; Journal of Spinal Disorders and Techniques: editorial or governing board; K2M spine: research support; K2Medical: paid consultant; OMEGA: research support; PACIRA: research support; SMISS: board or committee member; Synthes: paid consultant; paid presenter or speaker; Thieme, QMP: publishing royalties, financial, or material support. E.Y.K.: Biomet: paid consultant; DePuy, A Johnson & Johnson Company: paid presenter or speaker. K.E.B.: K2M. The remaining authors declare no conflicts of interest.

Reprints: Steven C. Ludwig, MD, Department of Orthopaedics, School of Medicine, University of Maryland, 110 South Paca Street, 6th Floor, Suite 300, Baltimore, MD 21201 (e-mail: sludwig@som.umaryland.edu).

Received September 9, 2018

Accepted January 8, 2019

© 2019 by Lippincott Williams & Wilkins, Inc.