Blind Spots in Spine Imaging

Mougnyan Cox, MD; Linda Bagley, MD; Joseph Philip, MD; Joshua Thatcher, MD; Ike Thacker, MD; Conan Gomez; Kennith Layton, MD


Appl Radiol. 2022;51(2):15-23. 

In This Article

Abstract and Introduction


Spine-imaging volumes are increasing, paralleling the rising number of aging Americans seeking care for back and neck pain.[1] The most common reason for nontraumatic outpatient spine imaging remains osteoarthritis, which is more common in older patients.[2] In addition, the sustained attention required for level-by-level-analysis of degenerative changes creates a unique environment for extraspinal findings to go undetected by a busy radiologist.

Anecdotally, the potential for diagnostic error is affected by several factors, including the complexity of the diagnostic imaging study, the presence of one or more abnormalities, the expertise of the interpreting physician, the number and type of interruptions, and even the timing of interpretation (early versus late into a work shift). For example, at least one study has shown that errors are more likely to be made in the last two hours of a long shift.[3] Multiple studies in radiology have also found that detection errors are more common than interpretive errors.[4–6] This is especially relevant to spine imaging, where differential diagnoses for perceived abnormalities tend to be less complex than those for brain imaging. Occasionally, an extraspinal finding may be more serious than the original study indication, making detection even more important. In this article, we provide guide to some common "blind spots" in spinal imaging.