Incidental extra-spinal lesions on preoperative lumbar spine CT: frequency, clinical significance, and management...

BackgroundWith the increased use of preoperative imaging for lumbar spine surgery, incidental extra-spinal findings are frequently detected, but their clinical relevance is not fully understood. Assessing the frequency and impact of these findings is essential for patient safety and surgical planning.PurposeTo investigate the frequency and clinical significance of extra-spinal incidental findings on preoperative computed tomography (CT) in patients undergoing lumbar spine surgery.Material and MethodsA retrospective review was conducted of 417 patients (236 men, 181 women; mean age = 71.5 ± 13.9 years) who underwent preoperative lumbar spine CT examinations between July and October 2023. All imaging reports were reviewed, and extra-spinal incidental findings were extracted and classified using the CT Colonography Reporting and Data System (C-RADS; E2-E4). Prevalence, severity, and the need for further management were analyzed by age group. Statistical analysis included the Mann-Whitney U test, Spearman's rank correlation, and Kruskal-Wallis test (P <0.05).ResultsIncidental extra-spinal findings were observed in 194/417 (46.5%) patients. C-RADS E2, E3, and E4 findings were detected in 133 (31.9%), 29 (7.0%), and 36 (8.6%) patients, respectively. Both the prevalence and severity of incidental findings increased with age. Among E4 cases, 15 required referral or further workup, and surgery was postponed in four patients due to adrenal tumors.ConclusionClinically significant extra-spinal incidental findings are common in preoperative lumbar spine CT, particularly among older patients. Implementation of appropriate reporting systems and multidisciplinary communication is crucial to ensure timely management of clinically important lesions and to enhance patient safety during preoperative evaluation.