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Evidence to Improve Care

Positional Magnetic Resonance Imaging for People with Ehlers-Danlos Syndrome or Suspected Craniovertebral or Cervical Spine Abnormalities

Ontario Health Technology Advisory Committee Recommendations

  • Given the current absence of evidence for the utility of positional magnetic resonance imaging (positional MRI), the Ontario Health Technology Advisory Committee recommends that positional MRI not be funded or considered generally accepted practice for the diagnosis or management of (a) spinal or craniovertebral abnormalities among individuals with Ehlers-Danlos syndrome, or (b) major craniovertebral or cervical spine abnormalities among symptomatic individuals.

Read the full OHTAC Recommendation

Ehlers-Danlos syndrome is an inherited medical condition affecting the connective tissues (such as skin and joints) that help hold the body together. This condition can lead to loose and unstable joints, which may also cause severe pain and other problems in the spine or the craniovertebral junction (the place where the skull meets the spine). There are also several other conditions that can increase the risk of similar problems in the cervical (upper) spine and craniovertebral junction.

Health Quality Ontario Reviews Positional Magnetic Resonance Imaging for Specific Spinal Abnormalities

Positional MRI is a newer type of diagnostic imaging that allows patients to sit, stand or take other positions throughout the scanning process. Some experts believe patients with Ehlers-Danlos syndrome or suspected cervical spine or craniovertebral abnormalities might benefit from this technology because it might better detect abnormalities only visible when the patient is upright. Appropriate imaging and diagnosis is important to determine the best way to manage and treat these conditions.

Positional Magnetic Resonance Imaging for People with Ehlers-Danlos Syndrome or Suspected Craniovertebral or Cervical Spine Abnormalities: An Evidence-Based Analysis
July 2015 (PDF)

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The Ministry of Health and Long-Term Care has accepted this recommendation.

The Ministry of Health and Long-Term Care has provided the following response: Positional (upright) MRI is currently not available in Ontario.

Health Technology Assessment at Health Quality Ontario

As part of our core function to promote health care supported by the best available evidence, we use established scientific methods to analyze the evidence for a wide range of health interventions, including diagnostic tests, medical devices, interventional and surgical procedures, health care programs and models of care. These analyses are informed by input from a range of individuals, including patients and clinical experts. The Ontario Health Technology Advisory Committee — a committee of the Health Quality Ontario board of directors — reviews the evidence and makes recommendations about whether health care interventions should be publicly funded or not. Draft recommendations are posted on the Health Quality Ontario website for feedback. Final recommendations are approved by our board of directors and then shared with the Ministry of Health and Long-Term Care. For more detailed information, visit our Evidence to Improve Care pages.


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