Relationship between spinal magnetic resonance imaging findings and candidacy for spinal surgery.
OBJECTIVE
To compare the prevalence of spinal abnormalities found on magnetic resonance imaging (MRI) in symptomatic surgical candidates and non-surgical patients.


METHODS
Retrospective cohort study.


METHODS
A single academic spine surgery practice in Toronto, Ont.


METHODS
A total of 1586 symptomatic patients referred during a 32-month period; based on chart review, patients were classified as surgical candidates (n=722), non-surgical patients (n=690), or indeterminate regarding surgical candidacy (n=174).


METHODS
Prevalence rates of different spinal abnormalities between the 2 cohorts, including type, severity, and number of levels of abnormalities detected on lumbar MRI.


RESULTS
The total number of abnormalities did not differ between the 2 groups (P=.26). The non-surgical group exhibited more degenerative disk disease (P<.01), while surgical candidates had a higher prevalence of spinal stenosis and spondylolisthesis (P<.01). In multivariate analysis, age (adjusted odds ratio [AOR] per 10-year increase 3.33, 95% confidence interval [CI] 3.32 to 3.33), disk herniation (AOR 1.49, 95% CI 1.16 to 1.89), spinal stenosis (AOR 1.61, 95% CI 1.26 to 2.05), and spondylolisthesis (AOR 2.83, 95% CI 2.08 to 3.88) were independent predictors of surgical candidacy.


CONCLUSIONS
These results might enable physicians without specialty training in spinal disorders to more effectively use MRI reports when deciding on referral to surgical or non-surgical specialists. In jurisdictions with long wait times for elective spinal surgery consultation, a more directed referral is one of many steps necessary to improve patient access and management.
Cheng
Frederick
F
University of Toronto, Department of Surgery, Toronto Western Hospital East Wing 1-441, 399 Bathurst St, Toronto, ON M5T 2S8.
You
John
J
Rampersaud
Y Raja
YR
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000453:epidemiology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013115:Spinal Canal / Q000002:abnormalities / Q000000981:diagnostic imaging; D013130:Spinal Stenosis / Q000175:diagnosis* / Q000453:epidemiology; D013168:Spondylolisthesis / Q000175:diagnosis* / Q000453:epidemiology; D014656:Vascular Surgical Procedures