Utility of Early Postoperative Clinic Imaging Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

Abstract

Retrospective cohort study. To evaluate whether routine full-length spine radiographs obtained at the initial postoperative clinic visit following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) influence the decision to return to the operating room (UPROR). Routine radiographic imaging is frequently obtained at early postoperative clinic visits following PSF for AIS, despite growing evidence that these images rarely alter clinical management. While intraoperative imaging has improved accuracy in implant positioning, limited data exist evaluating the utility of early outpatient imaging in pediatric spine populations. This study retrospectively evaluated consecutive AIS patients aged 11-19 who underwent PSF at a single institution between 2011 and 2022. Patients were divided into two groups based on postoperative follow-up: those who received in-person visits with routine radiographs, and those seen via telehealth without imaging. Demographic, perioperative, and radiographic data were collected from electronic medical records. The primary outcome was UPROR within 90 days of discharge. Comparative analyses were performed using Wilcoxon rank-sum and Fisher's exact tests. A total of 696 patients were included (mean age: 15 ± 2 y; 82% female). The overall 90-day UPROR rate was 0.14% (n=1/696), with the sole reoperation based on clinical findings (wound drainage and fluctuance), not imaging. No reoperations were attributed to findings on postoperative radiographs. There were no statistically significant differences in surgical or radiographic parameters between patients who had imaging and those who did not. Routine full-length spine radiographs obtained at the initial postoperative clinic visit following PSF in AIS patients did not influence the decision to return to the operating room. These findings support a more symptom-guided imaging approach to reduce radiation exposure and healthcare costs without compromising patient outcomes.