Routine imaging for anterior cervical decompression and fusion procedures: a survey study establishing current practice patterns

The number of anterior cervical decompression and fusion procedures performed annually in the United States rose 8-fold from 1990 to 2004. Imaging for anterior cervical decompression and fusion procedures contributes to health care costs and exposes patients and staff to radiation. Despite this, no standard of care for such imaging has been defined, and imaging practices have remained largely uncharacterized. The authors distributed a questionnaire at the 2011 Spine Study Group meeting. They received 72 responses (80% response rate) and included 67 in the analysis. All participants were attending spine surgeons practicing in the United States, 97% of whom had completed spine surgery fellowships. Median practice duration was 8 years. Practice type was evenly split between private and academic, and the median annual number of anterior cervical decompression and fusion procedures was 50. Intraoperatively, 68% of surgeons use fluoroscopy and 32% use plain radiographs; 60% take at least 1 image prior to incision; 78% place the localizer in the disk, whereas 22% place it in the vertebral body, and 45% always save these localizer images; 100% take images of the final construct before leaving the operating room, and 74% always save the final-construct images. Postoperatively but before discharge, 12% of surgeons take images in the recovery room, 33% take images in the radiology suite, and 2% take images in both locations. After discharge, surgeons follow their patients for a mean of 1.6 years, 96% with lateral views, 96% with anteroposterior views, 46% with flexion-extension radiographs, and 14% with computed tomography scans.