[Scanner and mechanical lumbar diseases in private practice. Apropos of 106 patients covered by the Caisse Maladie Régionale du Nord].

The aim of this study was to prospectively evaluate use of computed tomography (CT) of the lumbar spine in office practice. The "Caisse Maladie Régionale du Nord" provides health insurance to self-employed retailers and craft persons (92,500 people at the end of 1991). The authors prospectively studied 106 patients insured by this organisation (60 males, 46 females, mean age: 51.27 years) who underwent CT of the lumbar spine between August 2, 1991 and January 23, 1993. They examined all insurance claims (physician visits, surgery, drugs, physiotherapy, laboratory tests, imaging studies, and hospitalizations) filed by each study patient during the 4 months before and the 4 months after the index CT. Reason for the CT, specified on 65 of the 106 radiologist reports, were isolated low back pain and nerve root pain in 26.2% and 56.9% of the patients respectively. CT findings were discal prolapse in 27 patients (25.5%), facet joint osteoarthritis in 33 patients (31.3%), discal protrusion in 29 patients (27.4%) and were considered as normal in 19 patients (18%). CT was preceded by plain radiographs in 50% of patients, by a rheumatologist visit in 31%, by a visit to the sole general practitioner in 51%, by local steroid injection in 15%. During the 4 months subsequent to the index CT, 14 (13.2%) patients had surgery and one underwent chemonucleolysis. These findings suggest that consensus conference recommendations concerning lumbar spine CT are not currently being followed in France.