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

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.