Presurgical imaging, testing and injection utilization in elective thoracolumbar spine surgery candidates: a nationwide analysis from the CSORN database

• Published in: Canadian Journal of Surgery 2015-06, Vol.58, p.S61-S61
• Main Authors: Manson, Neil, Abraham, Edward, Green, Alana, McIntosh, Greg
• Format: Article
• Language: English
• Subjects: Back surgery; Pain; Ratings & rankings; Surgeons; X-rays
• ISSN: 0008-428X; 1488-2310

Background: The objective was to assess the utilization of imaging, tests and injections in spine surgery candidates in the 6 months before surgical booking. Methods: We conducted a retrospective analysis of prospectively collected data from the Canadian Spine Outcomes and Research Network (CSORN). Twelve spine surgery sites across Canada contributed patient data for possible spine surgery cases between October 2008 and September 2014. Patients (n = 527) had degenerative spinal pathology or deformity of the thoracolumbar region. Frequencies were tabulated to estimate some of the imaging, testing and spinal injection utilization by spine surgery candidates before surgeon consultation. Results: Patients reported 836 counts of 1 use, 274 counts of 2 uses, 126 of 3 and 236 counts of more than 3 uses. This equals a conservative estimate (if > 3 = 4) of 1471 imaging, tests and/or injections. The EMG/nerve conduction tests and bone scans were used the least. Magnetic resonance imaging had the highest prevalence of use, followed by X-rays. There was no statistically significant difference in the frequency of X-ray utilization in those with deformity, fracture or spondylolisthesis compared with those with infection, tumour, disc herniation, degenerative disc disease or stenosis. There was a significant difference in pain ratings by imaging frequency. Those with no X-ray had significantly higher leg pain ratings than those with more than 3 X-rays (p < 0.05). Patients with no CT imaging had the highest leg pain ratings; patients with more than 3 CT scans had the lowest leg pain ratings (p < 0.05). Those with 1 MRI had significantly higher leg pain ratings than those with more than 3 X-rays (p < 0.05). Conclusion: There is an inverse association between the amount of pain and the frequency of the imaging test. Despite numerous guidelines and published reports that suggest the limited value of X-raying patients with uncomplicated back pain, this imaging technique remains a popular choice. Patients requiring spine surgery demonstrate a high utilization of healthcare resources, including diagnostic imaging, on their pathway to the surgeon. Defining a Canadian strategy to manage and optimize the care and resource utilization for these patients is required.