Complex spine surgery linked with high postoperative CT scan utilization

Surgeons ordered CT scans at a high rate following complex spine surgery in recent study results and the investigators believe surgeons should consider actions that would reduce this rate.

“The study was to try to figure out and understand how frequently CT are ordered and completed on our patients after complex spine fusion surgery,” Vikas V. Patel, MD, chief of orthopedic spine surgery at the University of Colorado, told Orthopedics Today. “The result is that we order a lot. The unknowns are how many of those scans were clinically absolutely necessary and how many of those scans could be avoided? For example, routine CT scans to assess fusion are not likely necessary, but a CT to assess fusion in a patient with new or persistent pain might be more appropriate.”

To better understand when CT is used in complex spine surgery, Patel and his colleagues identified all patients in an insurance database who underwent complex and simple spine surgeries from 2007 to 2014. Complex surgeries included cervical, thoracic and lumbar instrumented fusions and simple surgery included discectomy and laminectomy. Researchers reviewed the CT and MRI frequency in those cases between 6 months and 5 years postoperatively.

Overall, researchers identified 140,660 complex spine procedures, 39,943 discectomies and 49,889 laminectomies. Surgeons used MRI more often postoperatively for all the procedures, however the use of diagnostic CT was greater for the complex procedures.

Patel and colleagues found postoperative CT imaging increased more than two-fold for complex surgeries in the time period studied. About 30% of patients who underwent complex spine surgery had at least one follow-up CT scan by 2 years postoperatively and 40% or more of those patients had a follow-up CT scan by 5 years, according to the results. However, researchers noted the prevalence of postoperative CT for simple surgeries was lower at all postoperative time points and it never exceeded 30% at any interval despite an increase in CT use of about three-fold over a 5-year period.

Patel noted widespread changes must be made to reduce the use of CT scans after complex spine surgery.

“We should think twice about ordering CT scans on our patients if we do not need absolutely need them or if we can find an alternative to CT,” he said.

Future research should focus on why CT is ordered and raising awareness of alternative methods to reduce the use of CT imaging, Patel said.

“A long-term goal would be to try to find instruments, screws and rods and other devices that might be more MRI-compatible and allow us to use MRI imaging instead of CT imaging when we need something more than a simple X-ray,” Patel said. – by Casey Tingle

Reference:

Patel VV, et al. BMC Musculoskelet Disord. 2017;doi:10.1186/s12891-017-1420-9.

For more information:

Vikas V. Patel, MD, can be reached at The Spine Center at University of Colorado Hospital, Anschutz Inpatient Pavilion, 1st Fl., 12605 E. 16th Ave., Aurora, CO 80045; email: vikas.patel@ucdenver.edu.

Disclosure: Patel reports no relevant financial disclosures.