The rationale of postoperative radiographs after cervical anterior discectomy with stand-alone cage for radicular pain

Abstract

Object Cervical anterior discectomy with stand-alone cage (CADC) placement is a known treatment for cervical radiculopathy due to a herniated intervertebral disc or an osteophyte. Routine radiographs are obtained at regular postoperative intervals, but the consequences of routinely obtained radiographs are not known. In this study, the authors evaluated whether postoperative plain radiographs influenced the medical or surgical treatment of patients who underwent CADC placement. Methods The charts and radiographs of all patients who underwent CADC placement in 2007 were retrieved and reviewed retrospectively. In addition, the charts and radiographs of 50 consecutive patients who were seen after a CADC was placed during a period in 2008 were studied prospectively. Special emphasis was given to any abnormalities seen on the radiographs and especially their influence on further treatment. Results The charts and radiographs of 82 patients were retrospectively examined. A total of 138 levels were addressed, and in the prospective series 75 levels were surgically treated. The subsidence rate in the retrospective series was 14.5%. In 1 patient a slight anteroposition of the cage was seen. None of the radiographic abnormalities were related to the outcome of the patient or contributed to a change in the patient's treatment. Conclusions Routine radiographs after CADC placement are not warranted. Intraoperative verification of the position of the cage is recommended. Obtaining radiographs are only mandatory when signs or symptoms suggesting a postoperative complication are present. The authors propose a new algorithm for the follow-up of patients after CADC placement.