# Temporal Trends in Spinal Imaging in Ontario (2002-2019) and Manitoba (2001-2011), Canada

## TL;DR

This study examines how spinal imaging use changed over time in two Canadian provinces, finding a significant rise in MRI use despite efforts to reduce unnecessary imaging.

## Contribution

The study provides province-specific, longitudinal data on spinal imaging trends in Canada, highlighting the effectiveness of interventions in reducing X-ray and CT use but not MRI use.

## Key findings

- Spine MRI utilization increased by 277% in Ontario and 350% in Manitoba over the study periods.
- Spinal X-ray and CT use decreased in Ontario but remained stable in Manitoba.
- Total costs for spinal imaging rose significantly in both provinces over time.

## Abstract

Background

Several studies have reported the overuse of spinal imaging, which, in Canada, led to several provincial pathways aimed at optimizing the use of imaging. We assessed temporal trends in spine imaging in two Canadian provinces.

Methods

We explored the use of X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) examinations of the cervical, thoracic, and lumbar spine regions among adults in Ontario (April 1, 2002, to March 31, 2019) and in Manitoba, Canada (April 1, 2001, to March 31, 2011) using linked Ontario Health Insurance Plan administrative databases and data from Manitoba Health. We calculated the age- and sex-adjusted rates of spinal X-ray, CT, and MRI examinations by dividing the number of imaging studies by the population of each province for each year and estimated the use of each imaging modality per 100,000 persons.

Results

The total cost of spine imaging in Ontario increased from $45.8 million in 2002/03 to $70.3 million in 2018/19 (a 54% increase), and in Manitoba from $2.2 million in 2001/02 to $5 million in 2010/11 (a 127% increase). In Ontario, rates of spine X-rays decreased by 12% and spine CT scans decreased by 28% over this time period, while in Manitoba, rates of spine X-rays and CT scans remained constant. Age- and sex-adjusted utilization of spinal MRI scans per 100,000 persons markedly increased over time in both Ontario (277%) and Manitoba (350%).

Conclusion

Despite efforts to reduce the use of inappropriate spinal imaging, both Ontario and Manitoba have greatly increased utilization of spine MRI in the past two decades.