Utility of routine postoperative imaging following posterior spinal fusion for AIS

The necessity of routine radiographic imaging after spinal fusion surgery is debated due to variations in surgeons' practices. The aim of this study is to determine the role of immediate postoperative radiographic imaging following posterior spinal fusion for AIS. Our hypothesis is that routine immediate postoperative radiographic imaging in patients with AIS undergoing posterior spinal fusion does not impact the decision to return to the operating room.

We conducted a retrospective cohort study of AIS patients (ages 11-19) who underwent PSF at a single institution. The proportion of unplanned returns to the operating room (UPROR) cases was estimated with a Clopper-Pearson 95% confidence interval. Risk factors for UPROR were compared using Wilcoxon rank-sum and Fisher's exact tests.

Among 527 patients, only 3 (0.5%) had UPROR, and just 1 (0.2%) returned due to routine postoperative imaging findings. Patients with and without UPROR had similar surgical times (321 vs. 277 min, p = 0.24), blood loss (18% of EBV vs. 14% of EBV, p = 0.29), and intraoperative tranexamic acid use (p = 0.52). No demographic or surgical factors differed between the groups. The estimated excess radiation burden was 36.36 mSv.

The decision to undergo reoperation based on routine immediate postoperative imaging findings is exceedingly rare. In addition, blood loss, surgical time, and use of TXA did not differ between those who did return to the operating room and those who did not. These findings demonstrate that most patients do not benefit from routine immediate postoperative imaging.