The utility of routine postoperative radiographs after cervical spine fusion

The senior author (JAG) recently published an article questioning the utility of routine postoperative radiographs after lumbar spine fusion. That study concluded that routine postoperative radiographs in the presence of a normal physical examination rarely change the clinician's management of these patients. Our aim was to repeat this protocol in patients after cervical spine fusion. We hypothesized that routine postoperative radiographs are unnecessary in most cases after cervical spine fusion.

The purpose of this study was to determine the usefulness of routine postoperative cervical spine radiographs after cervical spine fusion as to whether they help to guide clinical decision making within the first postoperative year.

This is a retrospective chart review of 383 patients who underwent a cervical spine fusion over a 5-year period. Seven different surgeons performed the cervical spine fusions. Our review assessed a total of 1,155 postoperative clinic visits.

Each clinical postoperative visit was reviewed. The history and exam were graded as either normal or abnormal, and any plain radiographs obtained were graded similarly as either normal or abnormal. Each patient's notes were followed up to 1 year postoperatively. Each patient had to have at least two postoperative visits with X-rays to be included in the study. We then noted any further action taken by the clinician based on the appearance of the radiograph in conjunction with the history and exam.

In patients with normal history and exam presentations, further action was taken only 5/879 (0.57%) of the time, sometimes even in the presence of abnormal radiographs. The actions included two surgical revisions, two prolongations of cervical collar immobilization, and one patient who underwent a flexion/extension radiographic evaluation and subsequent prolonged cervical collar immobilization. There were 276 visits with abnormal history and exam; of these, 34/276 (12.3%) had abnormal X-rays. Of the clinic visits with abnormal history and exam and abnormal X-rays, 15/34 (44%) went on to revision.

Routine postoperative radiographs after cervical spine fusion rarely appear to be of value when patients present with a normal history and exam and may expose patients to unnecessary diagnostic studies and expenses. Patients exhibiting a normal postoperative history and exam are likely to have no further additional action taken in the presence of either normal or abnormal radiographs.