BackBone: Journal of the American College of Spine Surgery

Background: There have been numerous studies highlighting abnormal lumbar spine magnetic resonance imaging (MRI) findings in asymptomatic patients, exhibiting a correlation of increased findings with age; however, little research has been done to investigate the likelihood of normal MRI scans in patients who present with lower back pain.¹This study is pertinent to understanding (1) whether MRI scans are given to patients who do not necessarily require such extensive testing and whether current profligate medical and (2) work-related expenses can be avoided.

Methods: In this study, 189 lumbar spine MRI scans of patients who were 30 years or younger, presenting with lower back pain following a personal or work-related injury, were analyzed for potential findings or lack thereof. The patients were grouped into categories of “normal MRI” and “abnormal MRI” findings based on criteria created by two board certified orthopedic surgeons.

Results: The results showed that approximately 23% of the subjects had “normal MRI” scans and therefore lacked any form of significant findings which should be suggestive of lower back pain. No gender difference was observed between complaints and MRI findings.

Conclusion: These results demonstrate that the MRI scans of a significant portion of patients (23%) reporting lower back pain do not show significant abnormalities sufficient enough to explain their symptoms. This may indicate that a more thorough screening process needs to be developed due to patients report their symptoms under the influence of psychological and psychosocial factors, or that current MRI technology does not allow visualization of some anatomical component that may be causing lower back symptoms in these patients, or perhaps their causative pathology in unrelated to the spine.

Surgical procedures are costly due to staffing, medication use and processing and maintenance of surgical equipment.  Surgical procedures involve a varying quantity of instrumentation depending on several factors including the degree of difficulty of the procedure and the individual surgeon’s needs and preferences.  Most facilities process unused surgical tools wasting labor and costs.   Trimming costs while maintaining quality of care is a constant challenge in healthcare.   This review discusses utilizing lean methodology to discover waste with surgical tools, implementing changes to common surgical tools and the feasibility of incorporating disposable tools.