Poster Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Introduction 
The use of routine radiographs following spinal fusion surgery is a common practice to monitor potential postoperative structural complications. However, the advantages of routine radiographs for patients with an uncomplicated postoperative course are not well described. It remains uncertain to what extent these routine radiographs lead to further diagnostic or therapeutic action. Moreover, unnecessary radiographs result in radiation exposure and high health care costs. The aim of this study was to evaluate the value of routine radiographs during the first year following spinal fusion surgery and to determine whether they influence clinical decision making.   

Methods 
A retrospective study was conducted to review all patients who underwent spinal fusion in the orthopaedic department of an academic hospital between 2017 and 2021. Only fusions of the cervical, thoracic and lumbar spine for a degenerative condition were included in this study. Patient and surgical characteristics, postoperative clinical course, radiograph results and therapeutic implications were recorded during the first 12 months after spinal fusion. 

Results 
A total of 433 patient visits of 157 patients who underwent spinal fusion for degenerative conditions were reviewed. Radiographs were obtained in 92% (n= 399) of the patient visits, with no radiographs documented for only 8% (n= 34) of the visits. For patient visits with a normal postoperative course (n= 335), 0.03% (n= 10) of the radiographs were abnormal (screw loosening (n= 6), adjacent level degeneration (n= 4)). In 4 of these cases, additional computed tomography imaging was performed, while no further action was taken in the remaining cases. In patient visits with an abnormal clinical course (n= 64), 88% (n= 56) of the radiographs were normal. In case of an abnormal postoperative course, further actions were unrolled 91% (n= 58) of the time even in the presence of normal radiographs. 

Discussion 
The added value of routine radiographs in the postoperative setting following spinal fusion surgery with a normal clinical course appears to be rather limited based on these preliminary results. Moreover, there is a tendency to opt for additional imaging, such as computed tomography or magnetic resonance imaging, in patients with an abnormal postoperative course, regardless of the radiographic findings.