Are routine radiographs needed in the first year after lumbar spinal fusions?

This is a retrospective chart review of 670 clinic notes from 202 patients who underwent posterior instrumented lumbar spinal fusions (LSF) over a 9-year period by a single surgeon.

This study's objective was to investigate the utility of routine radiographs in the first year after LSF to determine if they affect decision-making.

A review of the literature reveals an absence of studies investigating the need for radiographs in the immediate postoperative period after LSF.

Each patient's history and physical examination (H/E) and the surgeon's interpretation of radiographs were graded as normal or abnormal for all postoperative visits in the first year after surgery. Further action taken not felt to be routine was also recorded. chi was used to statistically analyze the compiled data.

No action was taken 100% of the time when H/E was normal and either a normal radiograph or no radiograph was taken. If the patient was H/E normal and radiographs were abnormal, further action was taken in only one instance. This occurred in a patient with asymptomatic implant dissociation who elected to undergo revision. In patients with abnormal H/E, further action was taken 72% of the time even in the presence of normal radiographs and 89% of the time when they also had abnormal radiographs. There was no statistical difference between the 2 groups with abnormal H/E.

Routine radiographs seem to have limited utility in the early postoperative period after instrumented LSF and may place patients with normal H/E at an increased risk of undergoing unnecessary diagnostic studies. Patients with abnormal H/E were more likely to undergo more extensive testing leading to additional treatment being prescribed regardless of the interpretation of the radiographs.