TY - JOUR
T1 - The effect of oblique magnetic resonance imaging on surgical decision making for patients undergoing an anterior cervical discectomy and fusion for cervical radiculopathy
AU - Schroeder, Gregory D.
AU - Suleiman, Linda Idris
AU - Chioffe, Michael A.
AU - Mangan, John J.
AU - McKenzie, James C.
AU - Kepler, Christopher K.
AU - Kurd, Mark F.
AU - Vaccaro, Alexander R.
AU - Savage, Jason W.
AU - Hsu, Wellington K
AU - Patel, Alpesh A
PY - 2019/6/1
Y1 - 2019/6/1
N2 - 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.
AB - 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.
KW - ACDF
KW - Cervical
KW - Fusion
KW - Magnetic resonance imaging
KW - Radiculopathy
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U2 - 10.14444/6041
DO - 10.14444/6041
M3 - Article
C2 - 31328096
AN - SCOPUS:85070113800
VL - 13
SP - 302
EP - 307
JO - International Journal of Spine Surgery
JF - International Journal of Spine Surgery
SN - 2211-4599
IS - 3
ER -