Skip to main content

Advertisement

SpringerLink
Log in

Is Routine Postoperative Radiologic Follow-up Justified in Adolescent Idiopathic Scoliosis?

  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study Design

Retrospective review.

Objectives

To determine whether routine periodic radiographic examination is worthwhile in adolescent idiopathic scoliosis (AIS) patients undergoing instrumented fusion with third-generation implants.

Summary of Background Data

In common practice, patients who have undergone surgery for idiopathic scoliosis are followed up for a minimum of 2 years by clinical assessment and routine radiographic study at 3, 6, 12, and 24 months. The radiation related to these examinations is not negligible. To our knowledge, the use of routine radiographic follow-up after posterior spinal fusion for adolescent idiopathic scoliosis has not been evaluated.

Methods

We retrospectively analyzed full-spine X-rays and clinical records from the first 2 postoperative years of 43 patients. We sought any clinical feature (eg, pain, deformity progression, material protrusion) justifying X-ray, and any relevant radiologic finding (eg, loss of correction, instrumentation loosening, junctional kyphosis).

Results

Excluding the immediate postoperative films, 14.8% of X-rays were clinically justified, 8.3% were associated with a relevant finding, and 4.3% led to a therapy change. All patients with clinical deformity progression had a relevant X-ray finding. Pain was associated with a relevant finding in 23.5% of cases (positive predictive value, 0.1); 7.4% of films with no clinical justification showed a relevant finding (negative predictive value, 0.86). Lower Risser sign increased the risk of having a relevant radiographic finding (p <.05).

Conclusions

With the current use of third-generation implants, routine biplanar postoperative X-rays at 3, 6, 12, and 24 months do not seem to be justified in AIS and should be avoided in mature, asymptomatic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Levy AR, Goldberg MS, Mayo NE, et al. Reducing the lifetime risk of cancer from spinal radiographs among people with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 1996;21:1540–7.

    Article  CAS  Google Scholar 

  2. Land CE. Radiation and breast cancer risk. Prog Clin Biol 1997;396:115–24.

    CAS  Google Scholar 

  3. Morin Doody M, Lonstein JE, Stovall M, et al. Breast cancer mortality after diagnostic radiography: findings from the U.S. Scoliosis Cohort Study. Spine (Phila Pa 1976) 2000;25:2052–63.

    Article  Google Scholar 

  4. Nash Jr CL, Gregg EC, Brown RH, Pillai K. Risk of exposure to x-rays in patients undergoing long-term treatment for scoliosis. J Bone Joint Surg Am 1979;61:371–4.

    Article  Google Scholar 

  5. Deschenes S, Charron G, Beaudoin G, et al. Diagnostic imaging of spinal deformities: reducing patients’ radiation dose with a new slot-scanning x-ray imager. Spine (Phila Pa 1976) 2010;35:989–94.

    Article  Google Scholar 

  6. Ronckers CM, Morin Doody M, Lonstein JE, et al. Multiple diagnostic X-rays for spine deformities and risk of breast cancer. Cancer Epidemiol Biomarkers Prev 2008;17:605–13.

    Article  Google Scholar 

  7. Kendrick D, Fielding K, Bentley E, et al. Radiography of the lumbar spine in primary care patients with low back pain: randomized controlled trial. BMJ 2002;322:400–5.

    Article  Google Scholar 

  8. Sweigert SE, Rowley R, Waiters RL, Dethlefsen LA. Cell cycle effect on the induction of DNA double-strand breaks by X-rays. Radiat Res 1988;116:228–44.

    Article  CAS  Google Scholar 

  9. Hall EJ, Giaccia AJ. Radiobiology for the radiologist. Philadelphia, Pa: Lippincott Williams & Wilkins; 2006.

    Google Scholar 

  10. Yamashita T, Steinmetz MP, Lieberman IH, et al. The utility of repeated postoperative radiographs after lumbar instrumented fusion for degenerative lumbar spine. Spine (Phila Pa 1976) 2011;23:1955–60.

    Article  Google Scholar 

  11. Romero NC, Glaser J, Walton Z. Are routine radiographs needed in the first year after lumbar spinal fusions? Spine (Phila Pa 1976) 2009;34:1578–80.

    Article  Google Scholar 

  12. Kant AP, Daum WJ, Dean SM, Uchida T. Evaluation of lumbar spine fusion: plain radiographs versus direct surgical exploration and observation. Spine (Phila Pa 1976) 1995;20:2313–7.

    Article  CAS  Google Scholar 

  13. Fogel GR, Toohey JS, Neidre A, Brantigan JW. Fusion assessment of posterior lumbar interbody fusion using radiolucent cages: x-ray films and helical computed tomography scans compared with surgical exploration of fusion. Spine J 2008;8:570–7.

    Article  Google Scholar 

  14. Blumenthal SL, Gill K. lumbar spine radiographs accurately determine fusion in postoperative patients? Correlation of routine radiographs with second surgical look at lumbar fusions. Spine (Phila Pa 1976) 1993;18:1186–9.

    Article  CAS  Google Scholar 

  15. Mok JM, Berven SH, Diab M, et al. Comparison of observer variation in conventional and three digital radiographic methods used in the evaluation of patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2008;6:681–6.

    Article  Google Scholar 

  16. Lehman RA, Lenke LG, Keeler KA, et al. Operative treatment of adolescent idiopathic scoliosis with posterior pedicle screw-only constructs: minimum three-year follow-up of hundred fourteen cases. Spine (Phila Pa 1976) 2008;33:1598–604.

    Article  Google Scholar 

  17. Stokes IAF, Ronchetti PJ, Aronsson DD. Changes in shape of the adolescent idiopathic scoliosis curve after surgical correction. Spine (Phila Pa 1976) 1994;9:1032–7.

    Article  Google Scholar 

  18. Kim YJ, Lenke LG, Kim J, et al. Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2006;31:291–8.

    Article  Google Scholar 

  19. Wang Y, Hansen EB, Hoy K, et al. Distal adding-on phenomenon in Lenke 1A scoliosis: risk factor identification and treatment strategy comparison. Spine (Phila Pa 1976) 2011;36:1113–22.

    Article  Google Scholar 

  20. Burton DC, Asher MA, Min Lai S. Scoliosis correction maintenance in skeletally immature patients with idiopathic scoliosis. Spine (Phila Pa 1976) 2000;25:61–8.

    Article  CAS  Google Scholar 

  21. Coe JD, Vincent A, Donaldson W, et al. Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium: a report of the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 2006;31:345–9.

    Article  Google Scholar 

  22. Miller P, Kendrick D, Bentley E, Fielding K. -effectiveness of lumbar spine radiography in primary care patients with low back pain. Spine (Phila Pa 1976) 2002;27:2291–7.

    Article  Google Scholar 

  23. Owen JP, Rutt G, Keir MJ, et al. Survey of general practitioners: opinions on the role of radiology in patients with low back pain. Br J Gen Pract 1990;40:98–101.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Committee to Assess Health Risk from Exposure to Low Levels of Ionizing Radiation, Board on Radiation Effects Research, Division on Earth and Life Studies, National Research Council of the National Academies. Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2. Washington, DC: National Academies Press; 2006.

    Google Scholar 

  25. The 2007 Recommendations of the International Commission on Radiological Protection. Ann ICRP 2007;37:1–322.

    Google Scholar 

  26. Wall BF, Haylock R, Jansen JTM, et al. Radiation risks from medical x-ray examinations as a function of the age and sex of the patient. Chilton, Didcot (UK): Health Protection Agency; 2011.

    Google Scholar 

  27. Fortin C, Feldman DE, Cheriet F, et al. Validity of a quantitative measurement tool of trunk posture in idiopathic scoliosis. Spine (Phila Pa 1976) 2010;35:988–94.

    Article  Google Scholar 

  28. Cota Aroeira RM, Soares Leal J, de Melo Pertence AE. New method of scoliosis assessment. Spine (Phila Pa 1976) 2011;36:1584–91.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Fundació Institut de Recerca Vall Hebron, Passeig Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Alba Vila-Casademunt MSc & Montse Domingo-Sàbat PhD

  2. servei de cirurgia ortopedica i traumatologia), Hospital Universitari Vall d’Hebron (Unitat de Raquis, Passeig Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Ferran Pellisé MD, PhD, Juan Bagó MD, PhD, Antonia Matamalas MD, Carlos Villanueva MD, PhD & Enric Càceres MD, PhD

Authors
  1. Alba Vila-Casademunt MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ferran Pellisé MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Montse Domingo-Sàbat PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Juan Bagó MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antonia Matamalas MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carlos Villanueva MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Enric Càceres MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alba Vila-Casademunt MSc.

Additional information

Author disclosures: AVC (none); FP (consultancy for DePuy Synthes Spine, a Johnson & Johnson Co., Biomet; grants from DePuy-Synthes Spine, K2M); MDS (none); JB (none); AM (none); CV (employment with Medcotech; royalties from Scient’x); EC (consultancy for Medtronic, DePuy Spine; expert testimony for Medtronic, DePuy Spine; grant from Valle Hebron Research Institute; payment for lectures from Medtronic; patents from Surgival, Exatch; royalties from Surgival, DePuy Spine; payment for the development of educational presentations from Medtronic, Zimmer, Kleos, DePuy Spine).

We acknowledge the Spanish Spine Society (GEER: Sociedad para el Estudio de les Enfermedades del Raquis) for encouraging the research activity and support.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vila-Casademunt, A., Pellisé, F., Domingo-Sàbat, M. et al. Is Routine Postoperative Radiologic Follow-up Justified in Adolescent Idiopathic Scoliosis?. Spine Deform 1, 223–228 (2013). https://doi.org/10.1016/j.jspd.2013.02.003

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.jspd.2013.02.003

Keywords

Search

Navigation