530 - The Use of MRI and Plain Radiographs among Adolescents with Back Pain...

General Session: Pediatric Spine

Presented by: S. Virk - View Audio/Video Presentation (Members Only)


S. Virk(1), F. Phillips(2), S. Khan(1)

(1) Ohio State University, Orthopaedics, Columbus, OH, United States
(2) Rush University Medical Center, Orthopaedics, Chicago, IL, United States


Background: Low back pain (LBP) and adolescent idiopathic scoliosis (AIS) are common pediatric diagnoses. The workup for these diagnoses can be highly variable and utilize significant healthcare resources. Although recent literature has offered standard algorithms for workup of these diagnoses, there has been no analysis to date on the utilization of imaging for workup of AIS and/or LBP.

Methods: The Humana Private Payer Database (HORTHO) was queried for clinical and financial information for patients with AIS and/or LBP. This was done with International Classification of Diseases (ICD-9) for LBP and AIS. Current procedural terminology (CPT) codes related to magnetic resonance imaging (MRI) and radiographs for the thoracolumbar spine were used to identify patients with LBP and/or AIS that utilized these diagnostic imaging modalities. Only patients between the ages of 10 and 19 were included within this analysis.

Results: The total number of patients with AIS and LBP was 18,696 and 56,560 respectively. Thoracolumbar imaging was used within the workup for 77.35% and 50.61% of patients with AIS and LBP respectively. MRI was used for 7.58% and 10.44% of patients with AIS and LBP respectively. Radiographic imaging was used for 76.47% and 47.14% for AIS and LBP respectively. There was significant variation in regional use of radiographs for LBP and AIS. Comparatively, there was minimal variation amongst regions in use of MRI for AIS. For patients with LBP the diagnoses with the highest use of MRI was “Sciatica” (29.07%). Of patients with an MRI, 20.87% never had a radiograph. Reimbursement per patient for radiographs was $164 and $239 for AIS and LBP respectively. Reimbursement per patient for MRI was $1,263 and $1,882 for AIS and LBP respectively.

Conclusion: There is substantial utilization of both MRI and radiographs for adolescents with LBP and/or AIS. The reimbursements for these imaging modalities is high and clinicians should be aware of the impact these diagnostic tests have on the patient and the overall healthcare system.