• Pradeep Suri, Eric N Meier, Laura S Gold, Zachary A Marcum, Sandra K Johnston, Kathryn T James, Brian W Bresnahan, Michael O'Reilly, Judith A Turner, David F Kallmes, Karen J Sherman, Richard A Deyo, Patrick H Luetmer, Andrew L Avins, Brent Griffith, Patrick J Heagerty, Sean D Rundell, Jeffrey G Jarvik, and Janna L Friedly.
• Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, Washington, USA.
• Pain Med. 2021 Jun 4; 22 (6): 1272-1280.

ObjectiveTo evaluate the effect of inserting epidemiological information into lumbar spine imaging reports on subsequent nonsurgical and surgical procedures involving the thoracolumbosacral spine and sacroiliac joints.DesignAnalysis of secondary outcomes from the Lumbar Imaging with Reporting of Epidemiology (LIRE) pragmatic stepped-wedge randomized trial.SettingPrimary care clinics within four integrated health care systems in the United States.Subjects238,886 patients ≥18 years of age who received lumbar diagnostic imaging between 2013 and 2016.MethodsClinics were randomized to receive text containing age- and modality-specific epidemiological benchmarks indicating the prevalence of common spine imaging findings in people without low back pain, inserted into lumbar spine imaging reports (the "LIRE intervention"). The study outcomes were receiving 1) any nonsurgical lumbosacral or sacroiliac spine procedure (lumbosacral epidural steroid injection, facet joint injection, or facet joint radiofrequency ablation; or sacroiliac joint injection) or 2) any surgical procedure involving the lumbar, sacral, or thoracic spine (decompression surgery or spinal fusion or other spine surgery).ResultsThe LIRE intervention was not significantly associated with subsequent utilization of nonsurgical lumbosacral or sacroiliac spine procedures (odds ratio [OR] = 1.01, 95% confidence interval [CI] 0.93-1.09; P = 0.79) or any surgical procedure (OR = 0.99, 95 CI 0.91-1.07; P = 0.74) involving the lumbar, sacral, or thoracic spine. The intervention was also not significantly associated with any individual spine procedure.ConclusionsInserting epidemiological text into spine imaging reports had no effect on nonsurgical or surgical procedure utilization among patients receiving lumbar diagnostic imaging.© The Author(s) 2021. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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