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Recovery Room Radiographs Not Found to Have Incremental Utility Above Intraoperative Images After Lumbar Fusion Procedures

Bohl, Daniel D., MPH; Gruskay, Jordan A., BA; Miller, Christopher P., MD; Varthi, Arya, MD; Ruiz, Ferrin K., BA; Whang, Peter G., MD; Grauer, Jonathan N., MD

doi: 10.1097/BRS.0b013e3182a527be
Diagnostics
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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

This is a retrospective review of 190 lumbar fusion procedures demonstrating that recovery room images are inferior to intraoperative images and offer little or no incremental clinical utility for detecting issues with surgical constructs. Recovery room imaging might be discontinued to realize savings in cost, radiation exposure, and time.

From the Yale School of Medicine, New Haven, CT.

Address correspondence and reprint requests to Jonathan N. Grauer, MD, Yale School of Medicine 800 Howard Ave, New Haven, CT 06510; E-mail: jonathan.grauer@yale.edu

Acknowledgment date: April 22, 2013. First revision date: June 26, 2013. Second revision date: July 10, 2013. Acceptance date: July 13, 2013.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, expert testimony, payment for lectures, stock/stock options, and grants/grants pending.

© 2013 by Lippincott Williams & Wilkins