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Utility of Early Postoperative Radiographs After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Pensak, Michael J. MD*; Lee, Mark C. MD; Bayron, Jennifer A. BS; Thomson, Jeffrey D. MD

doi: 10.1097/BRS.0000000000000219

Study Design. Retrospective.

Objective. Evaluate the ability of serial full-length spine radiographs to detect clinically significant implant-related (IR) and non–implant-related (NIR) radiographical abnormalities in the first 6 months after routine posterior spinal fusion for adolescent idiopathic scoliosis (AIS).

Summary of Background Data. Patients with AIS are exposed to repeated doses of ionizing radiation during the course of their treatment with potential consequences for their long-term health. Postoperative algorithms for AIS often involve frequent standing plain radiographs during the first 6 months after surgery to detect IR and NIR abnormalities that may impact a patient's clinical course. However, the actual clinical utility of such repeated spine radiographs has not been studied.

Methods. Retrospective chart and radiographical review was conducted at a single institution for patients with AIS after posterior spinal fusion between 2007 and 2012. Radiographical abnormalities identified on full-length spine radiographs or additional imaging modalities in the first 6 postoperative months were grouped into IR or NIR findings. The findings were considered clinically significant if they resulted in a deviation from an anticipated postoperative course or additional interventions.

Results. For 129 patients, 761 full-length spine radiographs were obtained in the first 6 postoperative months. Eight patients (11 radiographs) had IR or NIR abnormalities, with only 2 of these considered clinically significant. Seven of the remaining 121 were identified to have IR or NIR abnormalities using other imaging modalities, with 2 considered clinically significant. The sensitivity and specificity of a full-length spine radiograph for detecting a clinically significant abnormality was 50% and 95%, respectively.

Conclusion. Routine full-length spine radiographs used with high frequency in the first 6 months after posterior spinal fusion rarely detected a radiographical abnormality that resulted in a meaningful change to a patient's clinical management. Blanket postoperative screening algorithms should be reconsidered to minimize patient radiation exposure.

Level of Evidence: 3

Serial spine radiographs in the first 6 months after posterior fusion for adolescent idiopathic scoliosis were a poor screening test for clinically relevant implant-related or non–implant-related radiographical abnormalities in a cohort of 129 patients. A protocol of high-frequency spine radiographs in the early postoperative period should be reconsidered.

*University of Connecticut Health Center, Farmington, CT

Department of Orthopaedics, Connecticut Children's Medical Center, Hartford, CT; and

University of Connecticut Medical School, Farmington, CT.

Address correspondence and reprint requests to Mark C. Lee, MD, Department of Orthopaedics, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106; E-mail:

Acknowledgment date: September 5, 2013. First revision date: November 12, 2013. Second revision date: December 18, 2013. Acceptance date: December 19, 2013.

The device(s)/drug(s) that is/are the subject of this manuscript is/are not FDA-approved for this indication and is/are not commercially available in the United States.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, payment for lecture.

© 2014 by Lippincott Williams & Wilkins