Introduction: A recent study demonstrated that long-cassette x-rays can have significant impact on surgical planning for lumbar pathology. It remains unclear whether long-cassette x-rays may be similarly impactful for cervical pathology, especially since some cervical pathologies may be directly related to the TL spine.
Methods: 15 cases of cervical pathology were presented with a brief vignette and cervical imaging (x-rays and MRI/CT). Surgeons were asked to select a surgical plan, with 6 choices, ranging from least aggressive (cervical anterior- only with discectomy/corpectomy at one or more levels and fusion; 1 point) to the most aggressive (posterior 3- column osteotomy at or below mid-thoracic region with T/L fusion; 6 points). Cases were then reordered and presented with long-cassette standing x-rays and the same question. Results were compared based on cervical imaging only vs addition of long-cassette x-rays. 5 cases (controls) had normal global alignment and 10 cases (study group) had global malalignment.
Results: 157 surgeons completed the survey, predominantly from North (28%) or South (36%) America and Asia (15.6%). Specialties included orthopedic surgery (62%) and neurosurgery (38%), 79% completed spine fellowship, and responders had a mean 14 yrs in practice that was a mean of 78% spine (32% cervical) and 21% deformity. For study cases, extent of recommended surgery increased significantly with addition of long-cassette x-rays vs cervical imaging only (p=0.003). For control cases, no significant changes in surgery plans were identified with addition of long-cassette x-rays (p=0.106).
Conclusions: Long-cassette x-rays can have significant impact on surgical planning for cervical pathology. Surgeons should maintain a relatively low threshold for obtaining long-cassette standing x-rays when planning surgical treatment for significant cervical spine pathology.
Patient Care: This research will improve patient care by providing evidence for the benefits of the practice of maintaining a low threshold for obtaining long-cassette standing x-rays. This change of practice will ensure that global alignment is considered in the treatment of cervical pathologies.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) recognize the importance of global alignment when examining cervical pathologies, and 2) understand the role of long-cassette standing x-rays in planning for surgical treatment of cervical deformity.