Study design: Cross-sectional, questionnaire study.
Objective: To characterize imaging practices for 3 common lumbar spine procedures.
Summary of background data: As lumbar surgical procedures 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.
Methods: We distributed a single-page questionnaire to all attending spine surgeons at a United States spine conference (The Spine Study Group) in 2012.
Results: Forty-one of 74 surgeons (55.4%) completed and returned the questionnaire. 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, whereas 25%, 10%, and 5% use plain film; 80%, 59%, and 54% take images prior to skin incision; 59%, 98%, and 100% always take final images at the end of the procedure while still in the operating room. Postoperatively, 13%, 54%, and 54% of surgeons take images after patients have left the operating room but before they have been discharged. Interestingly, 10%, 50%, and 51% of surgeons not only take 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. Fifty-four percent, 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 computed tomographic scan to assess fusion.
Conclusion: Findings highlight extreme variability in practice associated with a notable lack of standard of care and provide a baseline for utility studies that may lead to more evidence-driven care.