TY - JOUR
T1 - Assessment of impact of standing long-cassette radiographs on surgical planning for lumbar pathology
T2 - An international survey of spine surgeons
AU - AOSpine North America
AU - International Spine Study Group
AU - Maggio, Dominic
AU - Ailon, Tamir T.
AU - Smith, Justin S.
AU - Shaffrey, Christopher I.
AU - Lafage, Virginie
AU - Schwab, Frank
AU - Haid, Regis W.
AU - Protopsaltis, Themistocles
AU - Klineberg, Eric
AU - Scheer, Justin K.
AU - Bess, Shay
AU - Arnold, Paul M.
AU - Chapman, Jens
AU - Fehlings, Michael G.
AU - Ames, Christopher
N1 - Funding Information:
The International Spine Study Group (ISSG) is funded through research grants from DePuy Synthes and individual donations, and AOSpine North America receives funding through DePuy Synthes. Dr. Ames is a consultant for DePuy, Medtronic, and Stryker; owns stock in Baxano Surgical and Doctors Research Group; holds a patent with Fish and Richardson, PC; and receives royalties from Aesculap and Biomet Spine. Dr. Smith is a consultant for Biomet and Nuvasive; has received clinical or research support from AOSpine NA and DePuy/ISSG for the study described; has received support from DePuy/ISSG for non-study-related clinical or research effort; and has received honoraria for teaching from Globus, DePuy, and Medtronic. Dr. Arnold is a consultant for Medtronic Sofamor Danek, Stryker Spine, and FzioMed; owns stock in Z-Plasty; and has received sponsored or reimbursed travel from AOSpine NA. Dr. Lafage owns stock in Nemaris Inc.; has received support from DePuy, SRS, NIH, and ISSG for non-study-related clinical or research effort; is a consultant for MSD and Medicrea; and has been a teacher/speaker for DePuy, K2M, NuVasive, and Nemaris Inc. Dr. Schwab owns stock in Nemaris Inc.; is a consultant for MSD, K2M, DePuy, and Medicrea; has received support from DePuy, MSD, and AO for non-study-related clinical or research effort; holds patents with MSD, Nemaris, K2M, and NuVasive; and has been a teacher/speaker for MSD, Nemaris Inc., and K2M. Dr. Bess is a consultant for K2 Medical, Allosource, and NuVasive; received clinical or research support from DePuy Synthes for the study described; has received support from Medtronic, K2 Medical, and Innovasis for non-study-related clinical or research effort. Dr.Klineberg has received grant and speaker fees from DePuy Synthes, a research grant and speakers fees from AOSpine, and a fellowship grant from OREF. Dr. Protopsaltis is a consultant for Medicrea, Biomet Spine, and Alphatec and has received support from Zimmer Spine for non-study-related clinical or research effort. Dr. Shaffrey is a consultant for Biomet, Globus, Medtronic, NuVasive, and Stryker; owns stock in NuVasive; and receives royalties from and holds patents with Biomet, Medtronic, and NuVasive.
Publisher Copyright:
©AANS, 2015.
PY - 2015/11
Y1 - 2015/11
N2 - OBJECT: The associations among global spinal alignment, patient-reported disability, and surgical outcomes have increasingly gained attention. The assessment of global spinal alignment requires standing long-cassette anteroposterior and lateral radiographs; however, spine surgeons routinely rely only on short-segment imaging when evaluating seemingly isolated lumbar pathology. This may prohibit adequate surgical planning and may predispose surgeons to not recognize associated pathology in the thoracic spine and sagittal spinopelvic malalignment. The authors used a case-based survey questionnaire to evaluate if including long-cassette radiographs led to changes to respondents' operative plans as compared with their chosen plan when cases contained standard imaging of the involved lumbar spine only. METHODS: A case-based survey was distributed to AOSpine International members that consisted of 15 cases of lumbar spine pathology and lumbar imaging only. The same 15 cases were then shuffled and presented a second time with additional long-cassette radiographs. Each case required participants to select a single operative plan with 5 choices ranging from least to most extensive. The cases included 5 "control" cases with normal global spinal alignment and 10 "test" cases with significant sagittal and/or coronal malalignment. Mean scores were determined for each question with higher scores representing more invasive and/or extensive operative plans. RESULTS: Of 712 spine surgeons who started the survey, 316 (44%) completed the entire series, including 68% of surgeons with spine fellowship training and representation from more than 40 countries. For test cases, but not for control cases, there were significantly higher average surgical invasiveness scores for cases presented with long-cassette radiographs (4.2) as compared with those cases with lumbar imaging only (3.4; p = 0.002). The addition of long-cassette radiographs resulted in 82.1% of respondents recommending instrumentation up to the thoracic spine, a 23.2% increase as compared with the same cases presented with lumbar imaging only (p = 0.008). CONCLUSIONS: This study demonstrates the importance of maintaining a low threshold for performing standing long-cassette imaging when assessing seemingly isolated lumbar pathology. Such imaging is necessary for the assessment of spinopelvic and global spinal alignment, which can be important in operative planning. Deformity, particularly positive sagittal malalignment, may go undetected unless one maintains a high index of suspicion and obtains long-cassette radiographs. It is recommended that spine surgeons recognize the prevalence and importance of such deformity when contemplating operative intervention.
AB - OBJECT: The associations among global spinal alignment, patient-reported disability, and surgical outcomes have increasingly gained attention. The assessment of global spinal alignment requires standing long-cassette anteroposterior and lateral radiographs; however, spine surgeons routinely rely only on short-segment imaging when evaluating seemingly isolated lumbar pathology. This may prohibit adequate surgical planning and may predispose surgeons to not recognize associated pathology in the thoracic spine and sagittal spinopelvic malalignment. The authors used a case-based survey questionnaire to evaluate if including long-cassette radiographs led to changes to respondents' operative plans as compared with their chosen plan when cases contained standard imaging of the involved lumbar spine only. METHODS: A case-based survey was distributed to AOSpine International members that consisted of 15 cases of lumbar spine pathology and lumbar imaging only. The same 15 cases were then shuffled and presented a second time with additional long-cassette radiographs. Each case required participants to select a single operative plan with 5 choices ranging from least to most extensive. The cases included 5 "control" cases with normal global spinal alignment and 10 "test" cases with significant sagittal and/or coronal malalignment. Mean scores were determined for each question with higher scores representing more invasive and/or extensive operative plans. RESULTS: Of 712 spine surgeons who started the survey, 316 (44%) completed the entire series, including 68% of surgeons with spine fellowship training and representation from more than 40 countries. For test cases, but not for control cases, there were significantly higher average surgical invasiveness scores for cases presented with long-cassette radiographs (4.2) as compared with those cases with lumbar imaging only (3.4; p = 0.002). The addition of long-cassette radiographs resulted in 82.1% of respondents recommending instrumentation up to the thoracic spine, a 23.2% increase as compared with the same cases presented with lumbar imaging only (p = 0.008). CONCLUSIONS: This study demonstrates the importance of maintaining a low threshold for performing standing long-cassette imaging when assessing seemingly isolated lumbar pathology. Such imaging is necessary for the assessment of spinopelvic and global spinal alignment, which can be important in operative planning. Deformity, particularly positive sagittal malalignment, may go undetected unless one maintains a high index of suspicion and obtains long-cassette radiographs. It is recommended that spine surgeons recognize the prevalence and importance of such deformity when contemplating operative intervention.
KW - Deformity
KW - Long-cassette imaging
KW - Lumbar
KW - Radiographs
KW - Spine alignment
KW - Surgery
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U2 - 10.3171/2015.1.SPINE14833
DO - 10.3171/2015.1.SPINE14833
M3 - Article
C2 - 26230421
AN - SCOPUS:84975217689
SN - 1547-5654
VL - 23
SP - 581
EP - 588
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 5
ER -