153 - Routine Imaging for Elective Lumbar Spine Surgery: A Questionnaire Stu...

#153 Routine Imaging for Elective Lumbar Spine Surgery: A Questionnaire Study

Image-Guidance, Navigation, Robotics

Poster Presented by: M.L. Webb

Author(s):

D.D. Bohl (1)
F.K. Ruiz (1)
M.L. Webb (1)
J.A. Gruskay (1)
J.N. Grauer (1)

(1) Yale Department of Orthopaedics and Rehabilitation, New Haven, CT, USA

Abstract

Purpose: As lumbar surgeries are performed with increasing frequency, it becomes incrementally more important to optimize patient care, minimize risk, and reduce associated costs. Imaging is an area for potential improvement; however, little has been done to characterize current imaging practices, compare imaging practices with current evidence, or establish a standard of care. The purpose of this study is to characterize the intraoperative and postoperative imaging practices for three common types of lumbar spine procedures.

Study methodology: We distributed a single page questionnaire to all attending spine surgeons at a United States spine conference (The Spine Study Group) in 2012. The questionnaire was designed to characterize intraoperative and postoperative imaging practices associated with posterior lumbar decompression, posterior lumbar fusion, and anterior lumbar fusion. Critically, questions were phrased to elicit practices for routine, uncomplicated cases.

Results: 41 out of 74 surgeons (55.4%) who were offered the questionnaire completed and returned it. All results are given for posterior lumbar decompression, posterior lumbar fusion, and anterior lumbar fusion, respectively.

Intraoperatively, 75%, 90%, and 95% of surgeons use fluoroscopy, while 25%, 10%, and 5% use plain film; 80%, 59%, and 54% take images prior to skin incision; 85%, 72%, and 72% always save at least one localizing image; 59%, 98%, and 100% always take final images at the end of the procedure while still in the OR; and, of surgeons who take final images, 96%, 97%, and 95% always save those images.

Postoperatively, 13%, 54%, and 54% of surgeons take images after patients have left the operating room but before they have been discharged—either in the PACU or radiology suite. Interestingly, 10%, 50%, and 51% of surgeons not only take and always save intraoperative images of their final constructs, but also take additional images before discharge.

Surgeons follow their postoperative outpatients with imaging for a mean of 0.4, 1.5, and 1.5 years. 54%, 98%, and 100% follow with anterior-posterior views; 56%, 93%, and 95% with lateral views; and 15%, 39% and 39% with flexion-extension films. For both anterior and posterior fusion, 26% routinely follow with CT scan to assess fusion.

Conclusions: These findings characterize current routine imaging practices for common lumbar spine procedures. Findings highlight extreme variability in practice associated with a notable lack of standard of care. Reported imaging in excess of that justified by evidence may be driven by the desire for documentation in the medico-legal practice environment. The findings presented here provide a baseline for utility studies that may lead to more evidence-driven care.