Diagnostic workup for lumbar degenerative disc disease (DDD) includes imaging such as radiography, MRI, and/or CT myelography. If a patient has unsuccessful nonoperative treatment, the surgeon must then decide if obtaining updated images prior to surgery is warranted. The purpose of this study was to investigate whether the timing of preoperative neuroimaging altered clinical outcome, as reflected by the subsequent rate of revision surgery, in patients with degenerative lumbar spinal pathology.
From the Health Care Service Corporation administrative claims database, adult patients (minimum age 55 years old) with lumbar DDD who underwent surgery including posterior lumbar decompression with and without fusion (1–2 levels) and at least 5 years of continuous coverage after the index surgery were identified. The chi-square test was used to determine differences in revision rates stratified by timing of each imaging procedure relative to the index procedure (< 6 months, 6–12 months, 12–24 months, or > 24 months).
Of 28,676 cases identified, 5128 (18%) had revision surgery within 5 years. The timing of preoperative MRI or plain radiography was not associated with revision surgery. Among the entire cohort, there was a lower incidence of revision surgery in patients who had a CT myelogram within 1 year prior to the index surgery (p = 0.017). This observation was strongest in patients undergoing decompression only (p = 0.002), but not significant in patients undergoing fusion (p = 0.845).
Routine reimaging prior to surgery, simply because the existing MRI is 6–12 months old, may not be beneficial, at least as reflected in subsequent revision rates. The study also suggests that there may be a subset of patients for whom preoperative CT myelography reduces revision rates. This topic has important financial implications and deserves further study in a more granular data set.
ABBREVIATIONSCPT = Current Procedural Terminology; DDD = degenerative disc disease; HCSC = Health Care Service Corporation.
Correspondence Leah Y. Carreon: Norton Leatherman Spine Center, Louisville, KY. firstname.lastname@example.org.
INCLUDE WHEN CITING Published online November 16, 2018; DOI: 10.3171/2018.8.SPINE18586.
Disclosures Dr. Glassman reports being an employee of Norton Healthcare; being a consultant for and receiving royalties from Medtronic; and being Past President of the Scoliosis Research Society. Dr. Carreon reports being an employee of Norton Healthcare; being a consultant for AOSpine; receiving funds for travel from the University of Southern Denmark and University of Louisville; being a member of the Editorial Advisory Board for Spine Deformity, The Spine Journal, and Spine; being a member of the University of Louisville IRB; and being a member of the Research Committee for the Scoliosis Research Society.
GerlingMCLevenDPassiasPGLafageVBiancoKLeeA: Risk factors for reoperation in patients treated surgically for degenerative spondylolisthesis: a subanalysis of the 8-year data from the SPORT trial. Spine (Phila Pa 1976)42:1559–15692017
GerlingMCLevenDPassiasPGLafageVBiancoKLeeA: Risk factors for reoperation in patients treated surgically for lumbar stenosis: a subanalysis of the 8-year data from the SPORT trial. Spine (Phila Pa 1976)41:901–9092016
LevenDPassiasPGErricoTJLafageVBiancoKLeeA: Risk factors for reoperation in patients treated surgically for intervertebral disc herniation: a subanalysis of eight-year SPORT data. J Bone Joint Surg Am97:1316–13252015
MerkleMMaierGDanzSKaminskyJTatagibaMSHebelaNM: The value of dynamic radiographic myelography in addition to magnetic resonance imaging in detection lumbar spinal canal stenosis: a prospective study. Clin Neurol Neurosurg143:4–82016