Annual Trends and Geographic Variation in the Utilization of Imaging in Pediatric Patients with Low Back Pain in the United States

Suraj Dhanjani, Majd Marrache, Varun Puvanesarajah, Jina Pakpoor, Amit Jain

Research output: Contribution to journalArticlepeer-review


Background: Low back pain (LBP) is increasing in the pediatric population. Advanced imaging, such as computed tomography and magnetic resonance imaging, performed for LBP imposes significant costs with little benefit. We investigated annual trends and demographic and geographic variation in spinal imaging for first-time pediatric presenters with LBP in primary care clinics. Methods: We queried a private administrative claims database for patients presenting with LBP who underwent plain radiography, computed tomography, and magnetic resonance imaging from 2011 to 2017. We used a Cochrane Armitage test of trend to determine significant annual variation in diagnostic imaging utilization during the study period. The χ2 test was used to determine demographic and geographic variation. Results: The study included 67,423 patients with mean age 15.2 ± 3 years. There was no significant change in radiography (34.8% in 2011 vs. 35.5% in 2017, P = 0.795) or computed tomography (1.6% in 2011 vs. 1.1% in 2017, P = 0.073), but there was a significant increase in magnetic resonance imaging (3.3% in 2011 vs. 4.5% in 2017, P = 0.017). Overall, there was no significant change in total imaging use (P = 0.895). Boys had higher rates of imaging compared with girls (40.2% vs. 35.6%, P < 0.001). Imaging rates significantly varied between regions across the United States (P < 0.001). The Midwest had the highest imaging rates (41%), while the Northeast had the lowest rates (31%). Conclusions: There was significant demographic and geographic variation but no significant annual change in total diagnostic spinal imaging for pediatric patients with LBP between 2011 and 2017, with rates of advanced imaging remaining relatively low.

Original languageEnglish (US)
Pages (from-to)e972-e978
JournalWorld neurosurgery
StatePublished - Feb 2021


  • Diagnostic imaging
  • Health services
  • Low back pain
  • Neurosurgery
  • Orthopedics
  • Pediatrics
  • Spine

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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