Utilization of CT scanning associated with complex spine surgery

Area of Science:

• Radiology
• Spine Surgery
• Medical Imaging

Background:

• Ionizing radiation exposure from CT scans poses cancer risks.
• Spinal imaging utilization has increased, but follow-up CT use post-surgery is understudied.
• Overutilization of CT scans needs identification to minimize radiation exposure.

Purpose of the Study:

• To quantify the association between spinal surgery and CT utilization.
• To estimate the frequency of follow-up CT imaging after spinal surgery.
• To identify patterns of CT use in postoperative spinal care.

Main Methods:

• Retrospective cohort study using an insurance database (Humana, Inc.) from 2007-2014.
• Analysis of CPT codes for spinal surgeries (complex: instrumented fusions; simple: discectomy, laminectomy) and imaging (CT, MRI).
• Follow-up imaging frequency assessed up to 5 years post-surgery.

Main Results:

• Postoperative CT prevalence after complex spine procedures more than doubled from 6 months (18%) to 5 years (≥40%).
• Patients undergoing complex spine surgery averaged two postoperative CT scans.
• CT prevalence for simple spinal procedures remained below 30%.

Conclusions:

• CT scanning is frequently employed for postoperative evaluation after complex spine surgery.
• Strategies to mitigate radiation risk are needed, including reducing nonessential scans and optimizing protocols.
• Considering alternative imaging modalities like MRI and using lower radiation doses are recommended.