Rudisill Katelyn E, Dhodapkar Meera M, Ratnasamy Philip P, Jeong Seongho, Grauer Jonathan N
From the Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT.
J Am Acad Orthop Surg Glob Res Rev. 2025 Jul 21;9(7). doi: 10.5435/JAAOSGlobal-D-25-00018. eCollection 2025 Jul 1.
Spine MRI is increasingly considered for patients presenting through the emergency department (ED). It was hypothesized that more MRIs are being obtained of the entire spine (relative to localized regions) over time, and there are inconsistencies in this practice.
Data were abstracted from the 2010 to 2021 M151Ortho PearlDiver national, multi-insurance, administrative data set. Patients who received spine MRI within 7 days of presenting through the ED were categorized as having had localized MRI (cervical, thoracic, lumbar, cervical and thoracic, or thoracic and lumbar) or total spine (cervical, thoracic, and lumbar). Patient characteristics were compared between these categories with multivariable analyses. Furthermore, the rate of follow-up MRI within 14 days of initial MRI was assessed and compared.
Of the 275,999 patients identified as undergoing spine MRI, 93.25% were localized MRI and 6.75% were total spine MRI. Over a decade, total spine MRIs increased from 4.85% in 2010 to 12.38% in 2021 (P < 0.0001). Independent predictive factors for receiving a total spine MRI included indication (trauma, infection, neoplasm with odds ratio [OR], 1.30 relative to degenerative), patient factors (younger age [OR, 1.47 per decade], male sex [OR, 1.21], higher comorbidity [OR, 1.38]), and nonclinical factors (region of the country West [OR, 1.32 relative to South] and insurance plan (Medicaid OR, 1.23 and Medicare OR, 1.10 relative to commercial; P < 0.0001 for each except 0.0005 for Medicare). Follow-up MRIs within 14 days were more likely for total spine MRI than for the localized MRI group (7.28% vs. 5.26%, P < 0.0001).
For patients presenting through the ED, total spine MRIs represent a small but growing minority of spine MRI scans obtained. The nonclinical factors associated with this decision and mildly increased need for follow-up scans after total relative to localized MRI suggest room for greater consistency of practice.
对于通过急诊科就诊的患者，脊柱磁共振成像（MRI）的应用越来越多。据推测，随着时间的推移，对整个脊柱进行MRI检查（相对于局部区域）的情况越来越多，并且这种做法存在不一致性。
数据取自2010年至2021年的M151Ortho PearlDiver全国性、多保险行政数据集。在通过急诊科就诊后7天内接受脊柱MRI检查的患者被分类为进行了局部MRI检查（颈椎、胸椎、腰椎、颈椎和胸椎或胸椎和腰椎）或全脊柱检查（颈椎、胸椎和腰椎）。通过多变量分析比较了这些类别之间的患者特征。此外，评估并比较了初次MRI检查后14天内的随访MRI检查率。
在确定接受脊柱MRI检查的275,999例患者中，93.25%进行了局部MRI检查，6.75%进行了全脊柱MRI检查。在十年间，全脊柱MRI检查的比例从2010年的4.85%增加到2021年的12.38%（P < 0.0001）。接受全脊柱MRI检查的独立预测因素包括指征（创伤、感染、肿瘤，相对于退行性病变的优势比[OR]为1.30）、患者因素（年龄较小[每十年OR为1.47]、男性[OR为1.21]、合并症较多[OR为1.38]）以及非临床因素（美国西部地区[相对于南部地区的OR为1.32]和保险计划（医疗补助计划的OR为1.23，医疗保险计划的OR为1.10，相对于商业保险计划；除医疗保险计划为0.0005外，每项P < 0.0001）。全脊柱MRI检查组在初次MRI检查后14天内进行随访MRI检查的可能性高于局部MRI检查组（7.28%对5.26%，P < 0.0001）。
对于通过急诊科就诊的患者，全脊柱MRI检查在获得的脊柱MRI扫描中占比虽小但呈增长趋势。与这一决策相关的非临床因素以及全脊柱MRI检查后相对于局部MRI检查随访扫描需求略有增加，表明在实践一致性方面仍有提升空间。
