The Utility of Plain Radiography in the Evaluation of Degenerative Spine Disease

Study Designs: Questionnaire, Retrospective chart review, Cadaver study, and crosssectional study. Objectives: Assess current imaging practices; determine utility of accessory radiographic studies, including dynamic and oblique radiographs; calculate effective radiation doses of routine spine radiographs. Summary of Background Data: Plain radiography is generally considered the initial imaging modality for evaluation of degenerative spine complaints. In addition to anteroposterior (AP) and lateral views, dynamic and oblique views may also be obtained. There is currently no data on imaging practices of spine specialists, the utility of these accessory radiographic views, or the radiation exposure patients receive as a result of various spine radiographs. Methods: A questionnaire study was developed to determine current imaging practices; retrospective chart review and cadaver studies were performed to determine the utility of dynamic and oblique radiographs, respectively; a cross-sectional study was utilized to determine radiographic exposures. Results: Imaging practices are varied amongst spine practitioners. The utility of dynamic films and cervical oblique films in the initial evaluation of spine complaints could not be supported. Radiation exposure from spine films is not negligible and lumbar films impart exposures an order of magnitude greater than corresponding cervical films. Conclusions: Sophisticated cost-benefit analyses are necessary to establish appropriate guidelines for the use of plain radiographs in the evaluation of spine complaints. Acknowledgements I would like to thank the following individuals for their assistance in my academic endeavors: To my friends and family, for their limitless encouragement and understanding; To Dr. Mark Horowitz for his commitment to high quality research; To Dr. Gary Friedlaender for his wisdom and leadership; To Dr. Peter Whang for his collegiality, tireless editing, and translation services; And to Dr. Jonathan Grauer, whose mentorship and guidance has meant so much to this and many other young clinician scientists. It is my great hope that his tremendous character and dedication will be reflected in my own career, as he represents all I aspire to in this profession. Table of