The Utility of Routine Postoperative Radiographs Following Surgical Treatment of Traumatic Cervical Spine Injuries

TL;DR

This study finds that routine postoperative X-rays after cervical spine surgery are not very useful for detecting hardware problems unless patients show symptoms.

Contribution

The study evaluates the clinical utility of routine postoperative radiographs in detecting instrumentation failure after cervical spine surgery.

Findings

Only 3 out of 11 revision surgeries were due to instrumentation failure detected by radiographs.

Routine radiographs had a sensitivity of 27% and specificity of 100% for detecting instrumentation failure.

Most revision surgeries were due to wound infection or epidural hematoma, not hardware issues.

Abstract

Background/Objectives: Postoperative cervical spine radiographs are routinely obtained during in-hospital and follow-up period. We aim to evaluate the utility of postoperative radiographs for identifying instrumentation failure and the subsequent need for revision surgery in patients with traumatic cervical spine injuries. Materials and Methods: A retrospective chart review of patients who had surgical treatment for traumatic cervical spine injury was conducted. Clinical notes and radiographic reports were evaluated. Postoperative radiographs were obtained prior to discharge from the hospital, and subsequently at 2, 6, 12, 24 weeks, and 1 year. Patients who underwent revision surgery, described as any reoperation, were identified. The patients’ indications for surgery were evaluated. The results of postoperative radiographs that prompted a change in management and reoperation were analyzed. Sensitivity and specificity for postoperative radiographs were calculated. Results: A total of 295 patients were reviewed. The rate of revision surgery was 3.7% (n = 11). All 11 patients presented changes in clinical findings and physical exam, but only 3 patients (1%) were identified to have undergone revision surgery due to instrumentation failure seen on radiographs at 13, 89, and 112 days postoperatively, and none within the inpatient period. Two patients underwent revision surgery due to epidural hematoma, and six patients due to wound infection. The overall sensitivity and specificity of routine postoperative radiographs were 27% and 100%, respectively. Conclusions: Postoperative radiographs after cervical spine trauma have low clinical utility for predicting instrumentation failure in the absence of clinical findings, particularly in the inpatient period.

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