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Utility of Repeat MRI in Patients With Degenerative Cervical Disease
Abstract:
Existing guidelines regarding indications for initial cervical spine magnetic resonance imaging (MRI) do not indicate when to perform repeat MRI in patients with previously documented degenerative disease. This study evaluates the efficacy of repeat MRI in patients with previously diagnosed degenerative cervical disease. Between 2013 and 2018, 153 patients (102 women, 51 men; mean age, 55 years; range, 19-81 years) without a history of trauma or surgery underwent cervical spine MRI 2 or more times at our institution indicated for symptoms of neck pain with or without radiculopathy. The MRI reports of repeat studies were reviewed and compared with index studies for notable changes. Notable radiographic changes were defined as any progression of the existing degenerative disease. Fifty-three of 153 (35%) patients demonstrated progression on repeat MRI. Forty-nine of the 53 patients demonstrating progression had new or worsening symptoms prior to their follow-up study (P=.03). Twenty-nine of 35 (83%) patients with new or worsening radiculopathy progressed on MRI (P<.01). Nine of 10 (90%) patients with new upper motor neuron findings demonstrated progression (P=.01). Axial neck pain alone was not statistically linked to MRI progression (P=.1). Twenty-five (16.3%) patients underwent operative management for their disease. Only 12 (48.0%) of the surgical patients presented MRI progression (P=.1). In the absence of new or worsening degenerative cervical symptoms, additional MRI studies are unlikely to reveal any radiographic progression or change clinical management from nonoperative to operative. [Orthopedics. 2023;46(2):98-102.].
Insights
Repeat cervical spine MRI is unlikely to show progression or alter treatment for degenerative disease unless new or worsening symptoms are present. This impacts clinical management decisions for neck pain patients.
Area of Science:
- Orthopedics
- Radiology
- Neurosurgery
Background:
- Current guidelines lack clear indications for repeat cervical spine MRI in patients with pre-existing degenerative conditions.
- Degenerative cervical disease management often involves follow-up imaging, but the utility of repeat MRI is not well-defined.
Purpose of the Study:
- To evaluate the efficacy and diagnostic yield of repeat cervical spine MRI in patients with previously diagnosed degenerative cervical disease.
- To determine if repeat MRI reveals significant radiographic progression and influences clinical management decisions.
Main Methods:
- Retrospective review of 153 patients (2013-2018) who underwent at least two cervical spine MRIs for neck pain or radiculopathy without trauma or surgery.
- Comparison of initial and follow-up MRI reports to identify notable radiographic changes, defined as progression of existing degenerative disease.
- Correlation of MRI findings with patient symptoms and subsequent treatment (operative vs. nonoperative).
Main Results:
- Thirty-five percent (53/153) of patients showed disease progression on repeat MRI.
- Progression was significantly associated with new or worsening symptoms, particularly radiculopathy (83%) and upper motor neuron findings (90%).
- Axial neck pain alone did not correlate with MRI progression, and only 48% of surgically treated patients had MRI progression.
Conclusions:
- Repeat cervical spine MRI is unlikely to reveal radiographic progression or change management from nonoperative to operative care in the absence of new or worsening degenerative cervical symptoms.
- Clinical correlation with new or worsening symptoms is crucial for determining the necessity of follow-up MRI in degenerative cervical spine disease.
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