Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Spine (Phila Pa 1976). 2013 Jan 1;38(1):51-9. doi: 10.1097/BRS.0b013e3182611182.
Retrospective cohort study.
To examine health care services use after a magnetic resonance imaging (MRI) scan of the lumbosacral or cervical spine ordered by a primary care physician.
The use of MRI of the spine in the primary care setting is increasing, yet little is known about the relationship between MRI scan findings and subsequent patterns of health care utilization.
Linkage of records from an audit of outpatient MRI scans of the spine performed in Ontario, Canada, to administrative databases.
Of the 647 patients who had a lumbosacral spine MRI scan ordered by a primary care physician, 288 (44.5%) were seen in consultation by an orthopedic surgeon or neurosurgeon, and 42 (6.5%) received spine surgery during 3 years of follow-up. Of the 373 patients who had a cervical spine MRI scan ordered by a primary care physician, 164 (44.0%) were seen in consultation by an orthopedic surgeon or neurosurgeon, and none had spine surgery during 3 years of follow-up. Patients with severe disc herniation (likelihood ratio, 5.62, 95% confidence interval, 2.64-12.00) or severe spinal stenosis (likelihood ratio, 2.34; 95% confidence interval, 1.13-4.85) on lumbosacral spine MRI were more likely to undergo subsequent surgery. However, many patients with these MRI abnormalities did not receive surgery, and the absence of these MRI findings did not significantly lower the likelihood of subsequent surgery.
Patients receiving MRI scans of the spine in the primary care setting are frequently referred for surgical assessment and most do not receive subsequent surgery. MRI scan results do not discriminate very well between those who will and will not undergo surgery, suggesting that alternative models for the assessment of patients with spinal complaints in primary care should be explored, particularly in jurisdictions with long wait times for elective spinal surgery consultation.
回顾性队列研究。
检查由初级保健医生开具的腰骶或颈脊柱磁共振成像（MRI）检查后的医疗服务利用情况。
在初级保健环境中使用脊柱 MRI 检查的情况正在增加，但对于 MRI 扫描结果与后续医疗保健利用模式之间的关系知之甚少。
将加拿大安大略省进行的脊柱 MRI 扫描的门诊记录与行政数据库进行链接。
在由初级保健医生开具腰骶部脊柱 MRI 检查的 647 名患者中，288 名（44.5%）接受了骨科或神经外科医生的会诊，42 名（6.5%）在 3 年随访期间接受了脊柱手术。在由初级保健医生开具颈椎 MRI 检查的 373 名患者中，164 名（44.0%）接受了骨科或神经外科医生的会诊，在 3 年随访期间没有进行脊柱手术。腰骶部 MRI 显示严重椎间盘突出（似然比，5.62，95%置信区间，2.64-12.00）或严重椎管狭窄（似然比，2.34；95%置信区间，1.13-4.85）的患者更有可能接受后续手术。然而，许多有这些 MRI 异常的患者并未接受手术，而这些 MRI 结果的缺失并不能显著降低随后手术的可能性。
在初级保健环境中接受脊柱 MRI 检查的患者经常被转介进行手术评估，大多数患者未接受后续手术。MRI 扫描结果并不能很好地区分哪些患者会接受手术，哪些患者不会接受手术，这表明应探索针对初级保健中脊柱疾病患者的替代评估模型，特别是在需要等待很长时间才能进行择期脊柱手术咨询的司法管辖区。
