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Preliminary Evaluation of Standing Full-Length Plain Radiographs Utility in an Adult Degenerative Spine Practice

Introduction: The role of weight-bearing full-length standing radiographs (FLSRs) of the spine in the preoperative workup of adult degenerative disease of the lumbar spine is a subject of increasing research. This investigation aims to determine whether FLSR influences preoperative planning decisions. Methods: In this prospective study, eight spine surgeons reviewed two 30-patient case series. The first set (set A) contained a patient history, physical examination data, and preoperative images. The second set (set B) contained all information in set A in addition to preoperative FLSR AP and lateral radiographs. Within 2 weeks of evaluating set A, reviewers assessed set B. Case sets were randomized. After reviewing each set, reviewers gave surgical plans and whether they believed an FLSR was important in planning. Decisions were evaluated by subspecialty, years of practice, and postfellowship years. A McNemar test assessed differences between set viewings. A chi-square test assessed differences of preoperative decision changes between different specialties and levels of experience. A Poisson regression assessed characteristics associated with changing preoperative plans. We analyzed patients by the number of unique reviewer procedures, surgical levels, and associated pathology. Results: After viewing an FLSR, 44.7% of reviewers changed procedure. Reviewer opinion of FLSR importance differed between sets (27.1% versus 35.7%, P = 0.047). Among all reviewers, FLSR presentation was associated with aligning the number of proposed procedures in 15 patients. Scoliosis and sacral dysplasia were associated with negative deltas. FLSR viewing reduced the span of operational levels considered. Along the most divided patients, those with a high magnitude (≥6 choices) of initial procedures had more negative deltas than did those with a high number (≥5 choices) of surgical level choices. Conclusion FLSR remains a critical aspect of presurgical planning. Even when reviewers initially believed patients would not benefit from FLSR, we observed changes in preoperative planning after FLSR viewing.