Regional Imaging
	Overland Park, Kansas         913-338-3344
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Utilization Review Guidelines/Medically Necessary:  BCBS CA
Computed tomography (CT) or magnetic resonance imaging (MRI) of the Cervical Spine

The use of computed tomography (CT) or magnetic resonance imaging (MRI) of the cervical spine is considered medically necessary when any of the following are present:

· Neck, shoulder, or upper extremity pain, with or without prior surgery, and documented focal neurologic deficit or abnormal findings on neurologic exam (i.e., motor weakness, dermatomal sensory loss, or significant reflex abnormality).

· Pain/radiculopathy in adults not improving despite 4 weeks of non-surgical treatment, which includes physical therapeutic modalities and appropriate pharmacologic intervention.  The 4-week requirement for treatment need not be applied to the pediatric patient or to those with documented rheumatologic disease with joint involvement.

· Acutely in the setting of major trauma.

· Recent less severe trauma to the spine with abnormalities on neurologic exam or abnormal x-ray or persistent increasing localized neck, shoulder, or upper extremity pain.

· Clinical suspicion of an infectious process such as abcess, osteomyelitis, or discitis involving the spine, spinal cord, or adjacent structures or spaces.

· Clinical suspicion ("Red Flags", see note) of primary cervical spine cancer with symptoms and/or signs suggesting involvement of the spine, spinal cord, meninges or positive bone scan in systemic processes.

· Known diagnosis of cancer with suspicion of metastases to the cervical spine, meninges, or spinal cord.

· Further investigation of spinal abnormality of unknown or uncertain cause seen on plain film.

· Clinical suspicion of cervical myelopathy or cervical nerve root compression with new onset of extremity weakness, bladder/bowel symptoms, ataxia, spasticity, spinal level sensory loss, etc.

· Signs/symptoms suggestive of spinal stenosis (weakness, spasticity, clonus, muscle wasting, generalized sensory loss, nerve root compression, hyperactive reflexes; suggestive x-ray findings).

· Significant scoliosis. For pediatric patients where imaging of the entire spine is needed an MRI may be more appropriate to minimize radiation exposure.

· Suspected spinal cord infarct or spinal cord tumor.

· In children, suspicion of congenital or acquired abnormalities of spine and/or spinal cord.

MRI ONLY: To delineate the presence or absence of demyelinating disease.