부산대학교 도서관

Patients referred to spine surgeons often present with previous advanced imaging and frequently expect repeat imaging of their disease. Numerous guidelines exist regarding indications for obtaining an initial cervical spine MRI, but it is unknown if and when to obtain a repeat MRI in patients with previously documented degenerative disease. The objective of this study is to retrospectively review patients with degenerative cervical disease to evaluate the efficacy of repeat MRI in the setting of diagnosed degenerative cervical disease. All cervical spine MRIs performed at a single institution between 2013 and 2018 were identified by the CPT codes: 72141, 72142, and 72156. Patients with two or more MRIs during the period were reviewed. Patients with imaging studies for tumor, trauma, demyelinating diseases, infection, and postoperative evaluation were excluded. Patients with repeat MRIs obtained for symptoms of neck pain with or without radiculopathy were included. MRI reports of repeat studies were reviewed and compared to index studies for notable changes. Notable radiographic changes were defined as progression of the existing degenerative disease. A faculty radiologist then reviewed the studies with notable changes to confirm these radiographic changes. The patients' charts were reviewed for demographic information, tobacco use, body mass index, presence of diabetes, hemoglobin A1c, occupation, and clinical symptoms related to cervical disease. During the five-year period there were 6,605 cervical MRIs of 5,754 patients, 154 (103 female, 51 male, mean age, 55 years, range; 19-81) patients representing 343 (5.2%) MRIs were included in the study. Fifty of 154 (32%) patients demonstrated progression on repeat MRI. Of the 50 patients demonstrating radiographic progression, 46 had new or worsening symptoms prior to their follow-up study (.00001). There was a significant difference in mean time interval between MRIs in the symptom free group demonstrating progression (1158 days) and the symptom free group without progression (554 days) (p=.004). None of the four patients with MRI progression and absent symptomatic changes were transitioned to operative management. There was no significant relationship with radiographic progression and gender, diabetes, BMI, or smoking. This study found that in the absence of new or worsening degenerative cervical symptoms, additional MRI studies are unlikely to reveal any radiographic progression. Patients who demonstrated progression in the absence of symptomatic changes did so on imaging studies performed significantly longer from their index MRIs compared to other patients without symptomatic changes and stable repeat MRIs. This highlights the known progressive nature of degenerative changes in the cervical spine which are found in an increasing number of asymptomatic patients in the general population with increasing patient age. Observation of these degenerations on repeat cervical spine MRI without symptomatic changes is unlikely to be of significant clinical utility. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]