Publication Articles

Making Spine MR Reports More Clinically Appropriate: A Questionnaire-based Survey of Sub-specialty Spine Surgeons (RSNA 2019, Sun Dec 01 – 06)

PURPOSE

MR reports have been unchanged for a long time, and clinical relevance of MR findings are being challenged in literature. We assess the weightage that spine surgeons give to certain aspects of the MR report, their preference for report structure and towards different modalities.

METHOD AND MATERIALS

An anonymous online survey, created in consultation with 5 spine surgeons, which included questions related measurement of spinal canal dimensions, information about nerve root impingement, anomalies and take-off, annular fissures, Modic changes, scoliosis and listhesis, was circulated amongst sub-specialist spine surgeons.

Preference for report format (every level reported, significant levels reported, pain chart diagram), and modality of investigation before surgery for lumbar degenerative disc disease was also recorded.

RESULTS

24 sub-specialist spine surgeons, with average 13.9 years’ experience (range: 3 – 30 years) from 6 cities, completed the questionnaire. Responses were weighted towards surgically relevant details such as effective spinal canal measurement (79%), nerve root impingement (91%), obvious anomalies at the level of significant disc (61%), level of nerve root take-off (75%), only details of posterior annular fissures (50%), and 25% surgeons preferred “hyperintense zone terminology”. Surprisingly, equal number of responses for Modic changes (62%), and for the possibility of inflammatory spondyloarthropathy (58%) or infection (67%) we obtained. On reporting formats, majority asked for only involved levels (71%) while 33% asked for every level. 33% asked for a diagrammatic pain chart. There was no consensus on reporting of scoliosis cases. Also, majority asked for information about cause of listhesis. As expected, for pre-surgical assessment for degenerative disc disease, MR (87%) with and X ray spine with flexion and extension (75%) was preferred while only 8.3% asked for plain CT and none asked for CT myelography.

CONCLUSION

These results highlight clinically relevant information that should be included on an MR report, including effective spinal canal dimensions, details of nerve root anomalies at the level of disc herniation, details of nerve root impingement. There was lack of consensus on Modic changes, format of report, and scoliosis assessment.

CLINICAL RELEVANCE/APPLICATION

Two-way communication between spine surgeons, and radiologists helps in generation of effective reports, that improve clinical outcomes.