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Comparison of Lumbar Spine MRI Review: CD Versus Film
Proceedings of the NASS 27th Annual Meeting / The Spine Journal 12 (2012) 22S–44S CONCLUSIONS: Foraminal area decreased significantly in extension when compared to flexion and neutral positions on MRI. Lumbar disc bulge and angular motion at each level contributed independently to decreases in foraminal area in extension, whereas translational motion had no effect on foraminal area. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.114
72. Comparison of Lumbar Spine MRI Review: CD Versus Film Christian I. Fras, MD1, Amanda L. Castilleja2; 1Haverford, PA, US; 2 Broomall, PA, US BACKGROUND CONTEXT: Increasingly, radiology facilities are making their MRI images (including MRI) available only on CD, not on traditional film. Advantages of this include ease of transport, and diminished cost for the radiology facility; disadvantages include the need for a computer to view the films, potential incompatibility with some computers, and potential loss of productivity on the part of the viewing physician. PURPOSE: Evaluate the impact on an orthopedic spine surgeon’s productivity, as measured by time consumption, of reviewing MRI images from a compact disc (CD) on an office computer, compared with reviewing an MRI on traditional film. STUDY DESIGN/SETTING: Prospective evaluation of time expenditure associated with review of lumbar spine MRI images on CD and film. PATIENT SAMPLE: Forty-six consecutive lumbar spine MRI studies reviewed by senior author, with all studies brought in by patient on either CD or film. OUTCOME MEASURES: Total time expended in association with review of lumbar spine images on either CD or film. METHODS: Forty-six consecutive MRI studies of the lumbar spine were reviewed. All were brought in by patients in the course of their office evaluations from a variety of institutions; 25 studies were on CD, 21 on film. All CDs were viewed using a desktop PC that used a Pentium Dual-Core Processor with Windows 7. All films were reviewed utilizing a standard 4-frame x-ray view box. A stopwatch was used to measure the time (in seconds) from when the study was removed from its envelope or case, to when it was returned to its envelope or case, having been reviewed and handwritten notes on the findings having been made. RESULTS: The mean total time needed to review a lumbar spine MRI study on CD was 229.76 (S.D.: 43.57) seconds; the mean time to review a lumbar spine MRI on film was 105.19 (S.D.: 32.37) seconds. The difference was statistically significant (p!0.05). CONCLUSIONS: Use of CDs as a means of transmitting data from imaging studies, including MRIs, has some potential benefits, but incurs significant cost for the treating physician, including the need for additional equipment (PCs) and their maintenance. More concerning, though, is the cost associated with diminished productivity: the time needed to review an MRI of the lumbar spine on CD was, on average, more than double that needed to review a lumbar MRI on film. This loss of efficiency represents a significant burden on the treating physician, and may ultimately translate into significant increased cost, diminished revenue, or both for the treating surgeon. Thus, the move to placing imaging studies on CD may in fact represent ‘‘cost shifting’’ rather than ‘‘cost saving’’. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.115
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73. Does Lumbar Paraspinal Muscle Fatty Degeneration Correlate with Aerobic Index and Oswestry Disability Index? Mark L. Prasarn, MD1, Glenn R. Rechtine, MD2; 1Bellaire, TX, US; 2Bay Pines VAHCS, Bay Pines, FL, US BACKGROUND CONTEXT: Greater physical fitness has been shown to predict less physical dysfunction and fewer depressive symptoms in patients with low back pain. PURPOSE: We sought to analyze whether the amount of paraspinal fatty degeneration correlates with a patients measured aerobic index to determine if findings on lumbar MRI scans can help predict physical fitness and functional outcomes. STUDY DESIGN/SETTING: A retrospective review was performed at a University Spine Center. PATIENT SAMPLE: Cohort of patients treated for low back and/or radicular leg pain. OUTCOME MEASURES: Oswestry Disability Index (ODI) and Aerobic Index (AI) METHODS: A retrospective review was performed on 172 patients following IRB approval. Inclusion criteria involved being seen by a spine surgeon for low back pain, and having a measured aerobic index, BMI, ODI, body fat percentage, and a recent lumbar MRI scan. The percentage of fatty muscle degeneration was graded by three reviewers using T2 weighted axial images at L3 and L5 using a newly proposed system that was validated independently. The system is graded as follows: Grade 1: 0-24%, Grade 2: 25% to 49%, Grade 3: 50% to 74%, Grade 4: 75% to 100%. An independent t-test was used for comparisons. RESULTS: The average aerobic index (AI) was 34.87, and the cohort was divided up into two groups: above average AI (89 patients) and below average AI (83 patients). For all paraspinal fat measurements and body fat percentage, the difference between the above and below average AI groups were statistically significant (p!0.05), with the least amount of paraspinal fatty degeneration and body fat in the greater AI group. Weight alone and BMI were not found to be significantly different between those with above average AI when compared to those below (p 5 0.491 and p50.122, respectively). There was a trend for lower ODI scores in the above average AI group (41.9 versus 46.1), but this did not reach statistical significance between the two groups (p50.075). For all patients it was shown that there was significantly less paraspinal fat at the L3 level as compared to L5 (p!0.001). CONCLUSIONS: We were able to show that patients with a higher AI have lower body fat percentages and lower amounts of fatty degeneration in their lumbar paraspinal musculature. The amount of paraspinal fatty degeneration therefore correlates with physical fitness. Patients with higher AI also showed a trend towards having a lower ODI score. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.116
74. Change in Canal Diameter with Position in the Cervical and Lumbar Spine as Assessed on Kinetic Magnetic Resonance Imaging Rodney D. Terrell, MD1, Bayan G. Aghdasi, BA2, Hirokazu Inoue, MD, PhD, Yanlin Tan, MD1, Scott R. Montgomery, MD4, Emrah Sayit, MD5, Jeffrey C. Wang, MD5; 1Los Angeles, CA, US; 2University of California Los Angeles, Los Angeles, CA, US; 4Venice, CA, US; 5UCLA School of Medicine, Santa Monica, CA, US BACKGROUND CONTEXT: Cervical spinal stenosis and compression are known risk factors for development of cervical spondylotic myelopathy, and lumbar spinal stenosis is a common cause for lumbar spinal
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
72. Comparison of Lumbar Spine MRI Review: CD Versus Film Christian I. Fras, MD1, Amanda L. Castilleja2; 1Haverford, PA, US; 2 Broomall, PA, US BACKGROUND CONTEXT: Increasingly, radiology facilities are making their MRI images (including MRI) available only on CD, not on traditional film. Advantages of this include ease of transport, and diminished cost for the radiology facility; disadvantages include the need for a computer to view the films, potential incompatibility with some computers, and potential loss of productivity on the part of the viewing physician. PURPOSE: Evaluate the impact on an orthopedic spine surgeon’s productivity, as measured by time consumption, of reviewing MRI images from a compact disc (CD) on an office computer, compared with reviewing an MRI on traditional film. STUDY DESIGN/SETTING: Prospective evaluation of time expenditure associated with review of lumbar spine MRI images on CD and film. PATIENT SAMPLE: Forty-six consecutive lumbar spine MRI studies reviewed by senior author, with all studies brought in by patient on either CD or film. OUTCOME MEASURES: Total time expended in association with review of lumbar spine images on either CD or film. METHODS: Forty-six consecutive MRI studies of the lumbar spine were reviewed. All were brought in by patients in the course of their office evaluations from a variety of institutions; 25 studies were on CD, 21 on film. All CDs were viewed using a desktop PC that used a Pentium Dual-Core Processor with Windows 7. All films were reviewed utilizing a standard 4-frame x-ray view box. A stopwatch was used to measure the time (in seconds) from when the study was removed from its envelope or case, to when it was returned to its envelope or case, having been reviewed and handwritten notes on the findings having been made. RESULTS: The mean total time needed to review a lumbar spine MRI study on CD was 229.76 (S.D.: 43.57) seconds; the mean time to review a lumbar spine MRI on film was 105.19 (S.D.: 32.37) seconds. The difference was statistically significant (p!0.05). CONCLUSIONS: Use of CDs as a means of transmitting data from imaging studies, including MRIs, has some potential benefits, but incurs significant cost for the treating physician, including the need for additional equipment (PCs) and their maintenance. More concerning, though, is the cost associated with diminished productivity: the time needed to review an MRI of the lumbar spine on CD was, on average, more than double that needed to review a lumbar MRI on film. This loss of efficiency represents a significant burden on the treating physician, and may ultimately translate into significant increased cost, diminished revenue, or both for the treating surgeon. Thus, the move to placing imaging studies on CD may in fact represent ‘‘cost shifting’’ rather than ‘‘cost saving’’. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.115
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73. Does Lumbar Paraspinal Muscle Fatty Degeneration Correlate with Aerobic Index and Oswestry Disability Index? Mark L. Prasarn, MD1, Glenn R. Rechtine, MD2; 1Bellaire, TX, US; 2Bay Pines VAHCS, Bay Pines, FL, US BACKGROUND CONTEXT: Greater physical fitness has been shown to predict less physical dysfunction and fewer depressive symptoms in patients with low back pain. PURPOSE: We sought to analyze whether the amount of paraspinal fatty degeneration correlates with a patients measured aerobic index to determine if findings on lumbar MRI scans can help predict physical fitness and functional outcomes. STUDY DESIGN/SETTING: A retrospective review was performed at a University Spine Center. PATIENT SAMPLE: Cohort of patients treated for low back and/or radicular leg pain. OUTCOME MEASURES: Oswestry Disability Index (ODI) and Aerobic Index (AI) METHODS: A retrospective review was performed on 172 patients following IRB approval. Inclusion criteria involved being seen by a spine surgeon for low back pain, and having a measured aerobic index, BMI, ODI, body fat percentage, and a recent lumbar MRI scan. The percentage of fatty muscle degeneration was graded by three reviewers using T2 weighted axial images at L3 and L5 using a newly proposed system that was validated independently. The system is graded as follows: Grade 1: 0-24%, Grade 2: 25% to 49%, Grade 3: 50% to 74%, Grade 4: 75% to 100%. An independent t-test was used for comparisons. RESULTS: The average aerobic index (AI) was 34.87, and the cohort was divided up into two groups: above average AI (89 patients) and below average AI (83 patients). For all paraspinal fat measurements and body fat percentage, the difference between the above and below average AI groups were statistically significant (p!0.05), with the least amount of paraspinal fatty degeneration and body fat in the greater AI group. Weight alone and BMI were not found to be significantly different between those with above average AI when compared to those below (p 5 0.491 and p50.122, respectively). There was a trend for lower ODI scores in the above average AI group (41.9 versus 46.1), but this did not reach statistical significance between the two groups (p50.075). For all patients it was shown that there was significantly less paraspinal fat at the L3 level as compared to L5 (p!0.001). CONCLUSIONS: We were able to show that patients with a higher AI have lower body fat percentages and lower amounts of fatty degeneration in their lumbar paraspinal musculature. The amount of paraspinal fatty degeneration therefore correlates with physical fitness. Patients with higher AI also showed a trend towards having a lower ODI score. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.116
74. Change in Canal Diameter with Position in the Cervical and Lumbar Spine as Assessed on Kinetic Magnetic Resonance Imaging Rodney D. Terrell, MD1, Bayan G. Aghdasi, BA2, Hirokazu Inoue, MD, PhD, Yanlin Tan, MD1, Scott R. Montgomery, MD4, Emrah Sayit, MD5, Jeffrey C. Wang, MD5; 1Los Angeles, CA, US; 2University of California Los Angeles, Los Angeles, CA, US; 4Venice, CA, US; 5UCLA School of Medicine, Santa Monica, CA, US BACKGROUND CONTEXT: Cervical spinal stenosis and compression are known risk factors for development of cervical spondylotic myelopathy, and lumbar spinal stenosis is a common cause for lumbar spinal
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.