Preoperative full-length standing radiographs and revision rates in lumbar degenerative scoliosis

Restricted access

OBJECTIVE

Full-length (36-inch) standing spine radiographs are commonly used by spine surgeons to evaluate patients with lumbar degenerative scoliosis (LDS). Despite this practice, the impact of these images on preoperative decision making and the rate of revision surgery has not been analyzed. The purpose of this study is to determine if preoperative full-length standing spine radiographs improve surgical decision making by decreasing the rate of revision surgery in patients with LDS.

METHODS

From the Health Care Service Corporation administrative claims database, the authors identified patients 50–80 years of age with LDS who had undergone surgery including posterior lumbar decompression and fusion over 2–6 levels and with at least 5 years of continuous coverage after the index surgery. Patients were stratified into the following groups, according to the preoperative imaging studies performed within 6 months before their index surgery: lumbar spine MRI studies only, lumbar spine MRI studies and standard lumbar spine radiographs, CT myelograms, and full-length standing spine radiographs. Survival analysis was performed with the occurrence of a revision within 5 years of the index surgery as the outcome of interest.

RESULTS

A total of 411 patients were included in the study after applying the inclusion and exclusion criteria. Revision surgery within 5 years after the index procedure was most frequent in the patients with preoperative MRI only (41.8%), followed by the patients with a CT myelogram (30.4%) and those with MRI and standard radiographs (24.8%). The lowest revision rate was seen among those with long-cassette standing radiographs (11.1%). Patients whose preoperative evaluation included full-length standing radiographs (OR 0.353, p = 0.034) and MRI studies plus radiographs (OR 0.650, p = 0.022) were less likely to require revision surgery at 5 years after the index procedure.

CONCLUSIONS

An assessment of standing alignment using full-length (36-inch) standing radiographs may be beneficial in reducing the risk of revision surgery in patients with lumbar scoliosis. This observation was not limited to patients with large curves or substantial deformity.

ABBREVIATIONS AUC = appropriate use criteria; HCSC = Health Care Service Corporation; LDS = lumbar degenerative scoliosis.

Article Information

Correspondence Leah Y. Carreon: Norton Leatherman Spine Center, Louisville, KY. leah.carreon@nortonhealthcare.org.

INCLUDE WHEN CITING Published online March 23, 2018; DOI: 10.3171/2017.10.SPINE17638.

Disclosures Dr. Carreon is an employee of Norton Healthcare, has been a consultant for AOSpine, has received travel funds from the University of Southern Denmark and the University of Louisville, and has received support from Pfizer for non–study-related clinical or research effort. Dr. Glassman is an employee of Norton Healthcare and holds a patent with, has been a consultant for, and has received royalties from Medtronic. NuVasive provided funds directly to the database company; no funds were paid to Dr. Glassman or Norton Healthcare.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Kaplan-Meier plot showing the proportion of patients requiring revision surgery after the initial index surgery among the 4 imaging modality cohorts: patients with full-length (36-inch) standing radiographs, standing lumbar radiographs, CT myelograms, and lumbar MRI.

References

  • 1

    Ailon TSmith JSShaffrey CILenke LGBrodke DHarrop JS: Degenerative spinal deformity. Neurosurgery 77 (Suppl 4):S75S912015

    • Search Google Scholar
    • Export Citation
  • 2

    Chen PGDaubs MDBerven SRaaen LBAnderson ATAsch SM: Surgery for degenerative lumbar scoliosis: the development of appropriateness criteria. Spine (Phila Pa 1976) 41:9109182016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Daubs MDLenke LGBridwell KHCheh GKim YJStobbs G: Decompression alone versus decompression with limited fusion for treatment of degenerative lumbar scoliosis in the elderly patient. Evid Based Spine Care J 3:27322012

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Gelb DELenke LGBridwell KHBlanke KMcEnery KW: An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine (Phila Pa 1976) 20:135113581995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Glassman SDBerven SHShaffrey CIMummaneni PVPolly DW: Commentary: Appropriate use criteria for lumbar degenerative scoliosis: developing evidence-based guidance for complex treatment decisions. Neurosurgery 80:E205E2122017

    • Search Google Scholar
    • Export Citation
  • 6

    Hosogane NWatanabe KKono HSaito MToyama YMatsumoto M: Curve progression after decompression surgery in patients with mild degenerative scoliosis. J Neurosurg Spine 18:3213262013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Jackson RPMcManus AC: Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine (Phila Pa 1976) 19:161116181994

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Lafage VSchwab FSkalli WHawkinson NGagey PMOndra S: Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine (Phila Pa 1976) 33:157215782008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Lowe TBerven SHSchwab FJBridwell KH: The SRS classification for adult spinal deformity: building on the King/Moe and Lenke classification systems. Spine (Phila Pa 1976) 31 (19 Suppl):S119S1252006

    • Search Google Scholar
    • Export Citation
  • 10

    Park JJCarreon LYGlassman SD: Adult lumbar degenerative scoliosis 40° or less: outcomes of surgical treatment with minimum 2-year follow-up. Spine Deform 1:2112162013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Ploumis ATransfledt EEDenis F: Degenerative lumbar scoliosis associated with spinal stenosis. Spine J 7:4284362007

  • 12

    Schwab FJSmith VABiserni MGamez LFarcy JPPagala M: Adult scoliosis: a quantitative radiographic and clinical analysis. Spine (Phila Pa 1976) 27:3873922002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Silva FELenke LG: Adult degenerative scoliosis: evaluation and management. Neurosurg Focus 28(3):E12010

  • 14

    Tribus CB: Degenerative lumbar scoliosis: evaluation and management. J Am Acad Orthop Surg 11:1741832003

  • 15

    Van Royen BJToussaint HMKingma IBot SDCaspers MHarlaar J: Accuracy of the sagittal vertical axis in a standing lateral radiograph as a measurement of balance in spinal deformities. Eur Spine J 7:4084121998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Vedantam RLenke LGKeeney JABridwell KH: Comparison of standing sagittal spinal alignment in asymptomatic adolescents and adults. Spine (Phila Pa 1976) 23:2112151998

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 163 163 11
Full Text Views 122 122 1
PDF Downloads 149 149 5
EPUB Downloads 0 0 0

PubMed

Google Scholar