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Are CT Scans Overutilized in the Workup of Vertebral Compression Fractures?

McGowan, Shane M., MD*; Ramski, David E., MD*; Homcha, Brittany, MD; Sokunbi, Gbolabo, MD*

doi: 10.1097/BSD.0000000000000816

Study Design: This was a retrospective chart review.

Objectives: Computed tomography (CT) does not aid in determination of compression fracture chronicity and contributes to higher cost and radiation exposure. An examination of extraneous imaging will help to guide appropriate workup.

Summary of Background Data: Cost for osteoporotic fracture treatment has been estimated at $17 billion annually; future costs are anticipated to increase by at least 50%.

Materials and Methods: A chart review evaluated patients who received kyphoplasty or vertebroplasty as part of compression fracture treatment. The primary end point of the study was analysis of unnecessary imaging obtained during workup. The secondary outcome was excess radiation exposure incurred from unneeded imaging studies.

Results: There were 104 instances (40.2% of n=259 workups) where patients underwent only magnetic resonance imaging (MRI) or bone scan after radiographs. There were 28 instances (10.8%) where patients underwent only radiographs with a comparison study. There were a total of 76 instances (29.3%) where patients underwent extraneous CT scans and 13 instances (5%) where patients underwent both MRI and bone scan, causing an average of 979.4 mGy cm additional radiation exposure.

Conclusions: We recommend an algorithm that favors radiographs with comparison study or acquiring either MRI or bone scan to determine acuity. If these are available, CT scan becomes unnecessary and incurs increased costs and radiation exposure.

*Department of Orthopaedics, St. Luke’s University Health Network, Bethlehem

Penn State University Milton S. Hershey Medical Center, Hershey, PA

All work was performed at St. Luke’s University Health Network, Bethlehem, PA.

The authors declare no conflict of interest.

Reprints: David E. Ramski, MD, Department of Orthopaedic Surgery, St. Luke’s University Health Network, 801 Ostrum Street, PPHP 2nd Floor, Bethlehem, PA 18015 (e-mail:

Received March 21, 2018

Accepted February 19, 2019

© 2019 by Lippincott Williams & Wilkins, Inc.