Imaging wish-list: The improvements spine surgeons most desire


Five spine surgeons discuss spinal imaging and the advancements they would like to see.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

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Question: What are the biggest improvements that you would like to see made in spinal imaging?

J. Brian Gill, MD, MBA. Nebraska Spine Hospital (Omaha). Imaging of the spine has improved tremendously over the years with better resolution of MRI scans and CT scans. This has enabled more accurate diagnoses, which in turn has led to better treatment options. I would like to see continued improvements in CT scans in terms of better resolution with less radiation. Focused CT scans for specific levels are an important step to reduce radiation. For example, obtaining a CT scan from L1-S1 is not necessary if the pathology is located at L4-S1. We do this quite regularly in our office but it is very difficult reproduce at other facilities even with repeated teaching and informational sessions. That's unnecessary radiation which is cumulative over time. I would also like to see MRI scans be used for image guidance solutions instead of CT-based technology. This would really help to reduce radiation exposure to the patient.

William Taylor, MD. Director of Spine Surgery, Vice Chairman of the Division of Neurological Surgery at University of California, San Diego: The next generation of imaging that includes basic biological parameters of the disc space. Much like we have DEXA for bone, we need to identify factors involved in disc degeneration, pain generators and imaging characteristics.

Brian R. Gantwerker, MD. Founder of The Craniospinal Center of Los Angeles: In terms of spinal imaging, intraoperative imaging should become available in most community hospitals. I would like to see the affordability and quality become more attainable. There are some exciting technologies, such as 3-D reconstruction with "standard" fluoroscopy machines, like the Ziehm device. I think as spinal imaging improves, accuracy and patient safety will just follow. And I do believe that physicians and hospitals must be reimbursed for its use by CMS and other payers as it improves quality and safety.

Don Johnson II, MD. Founder of Southeastern Spine Institute (Mount Pleasant, S.C.). Greatest need spinal doctors have currently is for weight-bearing MRIs. These would allow more accurate diagnosis and thus focused medical treatment. The imaging industry needs to focus on this aspect of scanning and I predict insurance will at some point require weight-bearing MRIs.


Alan S. Hilibrand, MD. Co-Director of Spine Surgery and Director of the Spine Fellowship at Rothman Institute (Philadelphia): Better ways to identify a spinal infection, especially in the period following surgery, and also better ways to minimize artifact in the cervical spine after prior surgery and instrumentation.

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