title: Value of repeat CT scans in low back pain and radiculopathy.
abstract: We assessed the clinical value of repeat spine CT scan in 108 patients aged 18-60 years who underwent repeat lumbar spine CT scan for low back pain or radiculopathy from January 2008 to December 2010. Patients with a neoplasm or symptoms suggesting underlying disease were excluded from the study. Clinical data was retrospectively reviewed. Index examinations and repeat CT scan performed at a mean of 24.3 ± 11.3 months later were compared by a senior musculoskeletal radiologist. Disc abnormalities (herniation, sequestration, bulge), spinal stenosis, disc space narrowing, and bony changes (osteophytes, fractures, other changes) were documented. Indications for CT scan were low back pain (60 patients, 55%), radiculopathy (46 patients, 43%), or nonspecific back pain (two patients, 2%). A total of 292 spine pathologies were identified in 98 patients (90.7%); in 10 patients (9.3%) no spine pathology was seen on index or repeat CT scan. At repeat CT scan, 269/292 pathologies were unchanged (92.1%); 10/292 improved (3.4%), 8/292 worsened (2.8%, disc herniation or spinal stenosis), and five new pathologies were identified. No substantial therapeutic change was required in patients with worsened or new pathology. Added diagnostic value from repeat CT scan performed within 2-3 years was rare in patients suffering chronic or recurrent low back pain or radiculopathy, suggesting that repeat CT scan should be considered only in patients with progressive neurologic deficits, new neurologic complaints, or signs implying serious underlying conditions.
authors.affiliation: Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: schroeder.josh@gmail.com.
authors.forename: Josh E
authors.initials: JE
authors.lastname: Schroeder
authors.affiliation: Department of Orthopedic Surgery, Shaare Tzedek Medical Center, POB 12000, Jerusalem 91120, Israel.
authors.forename: Yair
authors.initials: Y
authors.lastname: Barzilay
authors.affiliation: Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Leon
authors.initials: L
authors.lastname: Kaplan
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Itshayek
authors.affiliation: Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Nurith
authors.initials: N
authors.lastname: Hiller
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Computed tomography; Ionizing; Low back pain; Lumbar spine; Radiation; Radiculopathy; Spine CT