Boddu Chandrakanth, Jacobson Mark, Curtin Patrick B, Lawlor Caitlin E, Wood Kirkham, Grottkau Brian E
Adult Spine Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
Oakland Orthopaedic Surgeons, 30575 Woodward Avenue, Royal Oak, MI 48073, USA.
Spine Deform. 2019 Jan;7(1):146-151. doi: 10.1016/j.jspd.2018.05.017.
During the follow-up visits after Adult Spine Deformity (ASD) surgery, obtaining surveillance radiographs is a usual practice, and this study tried to identify evidence to support or refute such practice.
This is a retrospective, diagnostic case series (Level IV) of 49 patients. We identified the abnormal radiographic findings and their association with need for revision surgery. We determined the odds of obtaining an abnormal radiographs that lead to revision surgery at each of the given time intervals of follow-up. We also estimated the risk versus benefit of obtaining radiographs at each of the given time intervals of follow-up.
We identified a total of 11 individual types of abnormal postoperative radiographic findings. Of them, the two radiographic findings that always needed revision surgery because of the associated clinical presentation were pedicle screw pullout and bilateral rod fracture. One abnormal radiographic finding that was never associated with revision surgery was the halo around a pedicle screw. In each of the given postoperative time intervals of follow-up at which the routine radiographs were obtained, we noted that the odds of noticing abnormal radiographic finding that lead to revision surgery was always >1. We found that the cumulative hazard rate for exposure to radiation was significantly higher during the initial follow-up visits when compared to subsequent follow-up visits.
This study finds evidence to support the practice of routine postoperative radiographic evaluation of patients who come for follow-up after ASD surgery.
在成人脊柱畸形(ASD)手术后的随访期间,获取监测X光片是一种常见做法,本研究试图找出支持或反驳这种做法的证据。
这是一项对49例患者的回顾性诊断病例系列研究(IV级)。我们确定了X光片异常表现及其与翻修手术需求的关联。我们确定了在每个给定随访时间间隔内获得导致翻修手术的异常X光片的几率。我们还估计了在每个给定随访时间间隔内获取X光片的风险与益处。
我们共确定了11种术后X光片异常表现类型。其中,由于相关临床表现总是需要翻修手术的两种X光片表现是椎弓根螺钉拔出和双侧棒材骨折。一种从未与翻修手术相关的X光片异常表现是椎弓根螺钉周围的晕圈。在每次获取常规X光片的术后给定随访时间间隔内,我们注意到发现导致翻修手术的异常X光片表现的几率总是>1。我们发现,与后续随访相比,初始随访期间辐射暴露的累积风险率显著更高。
本研究发现有证据支持对ASD手术后前来随访的患者进行术后常规X光评估的做法。