Edwin Gulko MD, Abstract Co-Author: Nothing to Disclose

William Walter MD, Presenter: Nothing to Disclose

Judah Burns MD, Abstract Co-Author: Nothing to Disclose

To determine factors that increase the likelihood of new or progressive lumbar MRI findings in patients with a prior MRI.

Retrospective review was performed on ED patients with a lumbar MRI who had a prior MRI within 6 years. Demographics and "red flag” symptoms (malignancy, infection, fracture) were recorded. Lumbar MRIs were reviewed for acute findings (infection, new tumor, fracture, disc herniation, cord compression). Degenerative change was considered predominately facet joint arthropathy (FJA), degenerative disc disease (DDD), or both (BFD), and categorized as single or multi-level change. Images were compared with the prior MRI to assess change in canal stenosis. Odds Ratio analyses evaluated likelihood of worsening canal stenosis for single vs multi-level change, FJA vs DDD, and either FJA or DDD vs BFD.

285 lumbar MRIs were performed on patients with prior MRIs within 6 years. 7 cases were excluded. 136 patients (49%) had a "red flag". There were 66 cases with acute findings, 34 of which were patients with malignancy. Among 212 cases without an acute finding, 44 had more than 1 repeat exam and 16 had no degenerative change. As a result, 152 cases were evaluated for change in spinal canal stenosis. 42 (28%) had single level degenerative change and 110 (72%) had multilevel change. More patients with multilevel changes exhibited worsening spinal canal stenosis over time than patients with single level degeneration (OR 8.95, CI 2.0-39.2). There was no significant difference in the change in canal stenosis between patients with predominately FJA or DDD. More patients with BFD had worsening canal stenosis over time than patients with FJA or DDD (OR 2.9, CI 1.33-6.29).  

ED lumbar spine MRIs are commonly performed when prior MRIs exist. Clinical “red flags” increase the likelihood of acute findings, consistent with previously published data. Patients with single level degeneration and no acute finding are less likely to have progressive spinal canal stenosis. Progression is more likely in patients with both FJA and DDD, than in those with one or the other.

This research will help clarify the role of repeat lumbar MRIs in the ED for patients with various low back pain presentations and will allow for more prudent use of a limited imaging resource. Additionally we aim to explore which lumbar degenerative risk factors predispose to worsening spinal canal stenosis over time.

Gulko, E, Walter, W, Burns, J, Lumbar MRI Imaging in the Emergency Room Setting in Patients with a prior Examination: A Pain in the Back?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14002545.html