The effect of oblique magnetic resonance imaging on surgical decision making for patients undergoing an anterior cervical discectomy and fusion for cervical radiculopathy

Gregory D. Schroeder, Linda Idris Suleiman, Michael A. Chioffe, John J. Mangan*, James C. McKenzie, Christopher K. Kepler, Mark F. Kurd, Alexander R. Vaccaro, Jason W. Savage, Wellington K Hsu, Alpesh A Patel

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: The purpose of this study was to determine if oblique magnetic resonance imaging (MRI) sequences affect the surgical treatment recommendations for patients with cervical radiculopathy. Methods: In this cohort study consecutive clinical cases of persistent cervical radiculopathy requiring surgical intervention were randomized, blinded, and reviewed by 6 surgeons. Initially each surgeon recommended treatment based on the history, physical examination, and axial, coronal and sagittal preoperative magnetic resonance (MR) images; when reviewing the cases the second time, the surgeons were provided oblique MR images. This entire process was then repeated after 2 months. Change in surgical recommendation, interobserver and intraobserver reliability and the average number of levels fused was determined. Results: The addition of the oblique images resulted in the surgical recommendation being altered in 49.2% (59/ 120) of cases; however, the addition of oblique images did not substantially improve the interobserver reliability of the treatment recommendation (к = .57 versus.57). Similarly, the overall intraobserver reliability using only traditional MRI sequences (к = .64) was only slightly improved by the addition of oblique images (к = .66). Lastly, the addition of oblique images did not change the average number of levels fused (traditional MRI = 1.38, oblique MRI = 1.41, P = .53), or the total number of 3-level fusions recommended (6 versus 6, P = 1.00) Conclusions: The additional oblique images resulted in a change to the surgical plan in almost 50% of cases; however, it had no substantial effect on the reliability of surgical decision making. Further studies are needed to see if this alteration in treatment affects clinical outcomes.

Original languageEnglish (US)
Pages (from-to)302-307
Number of pages6
JournalInternational Journal of Spine Surgery
Volume13
Issue number3
DOIs
StatePublished - Jun 1 2019

Keywords

  • ACDF
  • Cervical
  • Fusion
  • Magnetic resonance imaging
  • Radiculopathy

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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