Surgery consultation common after MRI of the spine

John J. You, M.D., of McMaster University in Hamilton, Canada, and colleagues evaluated subsequent patterns of health care utilization in a retrospective cohort study involving 647 patients who had a lumbosacral MRI and 373 patients who had a cervical spine MRI scan ordered by a primary care physician.

After lumbosacral spine MRI, the researchers found that 44.5 percent of patients were seen by an orthopedic surgeon or neurosurgeon, and 6.5 percent ultimately underwent spine surgery during the subsequent three years. After cervical spine MRI, 44.0 percent were seen by an orthopedic surgeon or neurosurgeon, and none had surgery. Subsequent surgery was more likely for patients with severe disc herniation (likelihood ratio, 5.62) or severe spinal stenosis (likelihood ratio, 2.34) on lumbosacral spine MRI. Not all patients with these abnormalities underwent surgery and the absence of these findings was not associated with a significantly lower likelihood of subsequent surgery.

"We determined that MRI scans of the spine performed in symptomatic patients in primary care were almost always abnormal, subsequent surgical referral was frequent, and subsequent surgery was infrequent," the authors write. "Results of MRI scans were not strongly predictive of subsequent surgery and underscore the importance of clinical features of pain, functional limitation, and neurological involvement, and consideration of individual patients' values and preferences when making decisions about spinal surgery."

One or more authors disclosed receipt of a benefit from a commercial party.

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Journal reference: Spine

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