Introduction: Considerable variation exists in the utilization of MRI as a diagnostic tool in patients with spinal injuries. A global survey was organized by the AO Spine Spinal Cord Injury Knowledge Forum to formally assess MRI utilization by both Orthopedic and Neurosurgery Spinal Surgeons on a global scale.
Methods: A survey was conducted across the 6 global AO regions, registering respondent surgeons' specialty, training, scope of practice and background, in addition to MRI/CT availability at the location of practice and Trauma-level designation. Respondents were queried about spine trauma case simulations, including combinations of cervical, thoracic and lumbar injuries, as well as presence and degree of neurological deficit and time of presentation.
Results: 561 completed surveys were obtained. Variations in MRI utilization exist. On a global scale, practitioners in Africa did not obtain MRI scans for neurologically intact patients with spinal column injury. Practitioners in Europe and the Middle East exhibited a similar trend, to a lesser extent. Neurosurgical and Spine fellowship training backgrounds were also factors increasing the likelihood of ordering MRI scans for spine injury, as was increased number of years in practice, regardless of training subspecialty. No significant variation was detected with research affiliation, PhD degree, or dedicated research time designation. No significant variation was detected in ordering MRI trends across institutions with various trauma level designation, except a clear trend for practioners in Level 4 Trauma centers to order more MRIs. No variation was detected based on SCI volume of the institutions.
Conclusions: Multiple factors affect MRI utilization. MRI availability, patient resources as well as practitioner specialty, experience, and Trauma level designation impact the likelihood of obtaining an MRI for spine trauma. The most important factor was the presence of neurologic deficits in all regions of the spine.
Patient Care: Streamline current guidelines based on resource availability and neurologic status in SCI and reflect current practice trends.
Learning Objectives: Reporting the current trends in MRI imaging utilization in spine trauma . We inspect utilization across geographic and practitioner variations and report on the effect of availability, level, timing and extent of neurologic deficit on management decisions.