• Grant H Garcia, Min Jung Park, Keith Baldwin, John Flynn, and David A Spiegel.
• *The Hospital for Special Surgery, New York, NY †Hospital of the University of Pennsylvania, Philadelphia, PA; and ‡The Children's Hospital of Philadelphia, Philadelphia, PA.
• Spine. 2013 Dec 1;38(25):2216-20.

Study DesignThis is a retrospective review of 265 consecutive patients with scoliosis treated by posterior spinal fusion (PSF) and 2990 postoperative radiographs at a single institution.ObjectiveTo document implant-related complications on postoperative radiographs within the first 2 years after PSF and determine if these led to additional surgical procedures.Summary Of Background DataTo date, there is an absence of studies investing the utility of radiographs after pediatric PSF surgery.MethodsThe patient's average age was 14.9 years (8.2-21.8 yr). Positive radiographical findings included implant loosening, fracture, migration, or loss of fixation. We also noted which patients' required additional surgery for a radiographical finding and/or clinical finding (neurological deficit, intractable back pain, fever, and elevated erythrocyte sedimentation rate, c-reactive protein, or while blood cell count).ResultsAt an average follow-up of 16.3 months (12-24), only 18 (0.60%) radiographs demonstrated a positive finding. Of these, only 5 (0.17%) radiographs (along with clinical presentation) prompted revision. No patient returned to the operating room purely from a radiographical finding. The remaining 13 (0.37%) abnormal plain images were not associated with a clinical abnormality and were managed nonoperatively. The timing of the second operation was in the range from 1 day to 23 months (average, 11 mo). Postoperative plain radiographs had a sensitivity of 26.5%, a specificity of 99.5%, and a positive predictive value of 25%.ConclusionOnly 0.60% of postoperative images (18/2990) demonstrated an implant-related complication, and in the absence of clinical indications, none of these patients required surgical intervention. Isolated postoperative radiographs did not lead to any change in management, and consideration should be given to reviewing current protocols for plain radiographs as a monitoring tool after PSF.

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