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Do Routine Radiographs Within the First Two Years Following Pediatric Posterior Spinal Fusion Prompt Revision Surgery?

Garcia, Grant H. MD*; Park, Min Jung MD, MMSc; Baldwin, Keith MD, MPH, MSPT; Flynn, John MD; Spiegel, David A. MD

doi: 10.1097/BRS.0000000000000018

Study Design. This is a retrospective review of 265 consecutive patients with scoliosis treated by posterior spinal fusion (PSF) and 2990 postoperative radiographs at a single institution.

Objective. To document implant-related complications on postoperative radiographs within the first 2 years after PSF and determine if these led to additional surgical procedures.

Summary of Background Data. To date, there is an absence of studies investing the utility of radiographs after pediatric PSF surgery.

Methods. The patient's average age was 14.9 years (8.2–21.8 yr). Positive radiographical findings included implant loosening, fracture, migration, or loss of fixation. We also noted which patients’ required additional surgery for a radiographical finding and/or clinical finding (neurological deficit, intractable back pain, fever, and elevated erythrocyte sedimentation rate, c-reactive protein, or while blood cell count).

Results. At an average follow-up of 16.3 months (12–24), only 18 (0.60%) radiographs demonstrated a positive finding. Of these, only 5 (0.17%) radiographs (along with clinical presentation) prompted revision. No patient returned to the operating room purely from a radiographical finding. The remaining 13 (0.37%) abnormal plain images were not associated with a clinical abnormality and were managed nonoperatively. The timing of the second operation was in the range from 1 day to 23 months (average, 11 mo). Postoperative plain radiographs had a sensitivity of 26.5%, a specificity of 99.5%, and a positive predictive value of 25%.

Conclusion. Only 0.60% of postoperative images (18/2990) demonstrated an implant-related complication, and in the absence of clinical indications, none of these patients required surgical intervention. Isolated postoperative radiographs did not lead to any change in management, and consideration should be given to reviewing current protocols for plain radiographs as a monitoring tool after PSF.

Level of Evidence: 4

A total of 2990 postoperative radiographs of pediatric patients treated with posterior spinal fusion were reviewed. Only 18 demonstrated a positive finding, with only 5 associated with additional surgery and these 5 had an associated positive clinical examination. Isolated postoperative radiographs did not lead to any change in management, and consideration should be given to current protocols.

*The Hospital for Special Surgery, New York, NY

Hospital of the University of Pennsylvania, Philadelphia, PA; and

The Children's Hospital of Philadelphia, Philadelphia, PA.

Address correspondence and reprint requests to David A. Spiegel, MD, The Children's Hospital of Philadelphia, PA; E-mail:

Acknowledgment date: April 9, 2013. First revision date: June 17, 2013. Second revision date: August 29, 2013. Acceptance date: September 7, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, royalties, payment for manuscript preparation and stock/stock options.

© 2013 by Lippincott Williams & Wilkins