Back pain – should I get an MRI?

Category: Back Pain, Blog

If you want to be a good doctor – think twice about ordering an MRI for acute back pain. Here is what researchers at the  University of Connecticut Health Center said in reviewing published data:

The risks associated with early imaging for low back pain, includes:

1. patient “labeling,”
2. unneeded follow-up tests for incidental findings,
3. irradiation exposure,
4. unnecessary surgery,
5. and significant cost.

They suggest that routine imaging should not be pursued in acute low back pain as avoiding MRI use in acute low back pain patients will reduce risks and costs without affecting clinical outcomes.1

In other research doctors showed that over half (55.7%) of MRI recommendations for back pain were  either inappropriate or of uncertain value, and that family physicians were more likely to order inappropriate lumbar spine MRI than other physicians. 2

Not only inappropriate but risky – but patient’s expect an MRI to be ordered

Here is more research: “Available evidence indicates that immediate, routine lumbar spine imaging (MRI or CT) in patients with lower back pain and without features indicating a serious underlying condition did not improve outcomes compared with usual clinical care without immediate imaging.

In addition to lacking clinical benefit, routine lumbar imaging is associated with radiation exposure (radiography and CT) and increased direct expenses for patients and may lead to unnecessary procedures.

This evidence confirms that clinicians should refrain from routine, immediate lumbar imaging in primary care patients with nonspecific, acute or subacute low back pain and no indications of underlying serious conditions. Specific consideration of patient expectations about the value of imaging was not addressed here; however, this aspect must be considered to avoid unnecessary imaging while also meeting patient expectations and increasing patient satisfaction.”3

Patients expect an MRI – doctors do not want to disappoint

In a new study, doctors say that a surprisingly high percentage of patients have misconceptions regarding the diagnosis and treatment of lumbar spondylosis, and that these misconceptions persist in patients with a history of spine surgery. Specifically, patients overemphasize the value of radiological studies (MRIs and scans) and have mixed perceptions of the relative risk and effectiveness of surgical intervention compared with more conservative management.4

Unnecessary surgery based on MRI

MRI alone may provide insufficient or inaccurate information upon which to base surgical/technical decisions in about of 30% of cases (of back pain).”5

British Doctors and specialists at Southampton General Hospital in England noted in their own research that their own professionals could not agree on what the MRI said in diagnosing lumbar disc disease.

“we found in our study that there is wide variation in diagnosing lumbar disc disease between the Orthopaedic Surgeons and the Radiologists at our institution…Due to this amount of inaccuracy, it is risky to comment on degenerate disc disease on a plain radiograph alone. Therefore MRI scan should only be used to comment on the disc diseases of the low back, as plain radiographs are unreliable.”6

Before you consider the surgical option based on an MRI a consultation with a doctor trained in non-surgical treatment of ligament and tendon injuries, such as Stem Cell Therapy and PRP (Platelet Rich Plasma) Therapy, may be an option to surgery.

At the Magaziner Center for Wellness, we rarely if ever rely on an MRI. In our opinion these tests are a waste of money. A patient can come in with a big file of films and scans that cost them a lot of money out-of-pocket, and typically, there will be no useful information that will help us get the athlete back on the field. A skilled physician can make a more accurate determination of an athlete’s injury and treatment plan with a careful physical examination and history.

Unfortunately, there is a certain appeal to the patient to get an MRI, especially the athlete who thinks it is part of the normal process of treatment. It is sometimes difficult to get the patient to understand that when they get an MRI there will be a recommendation for a surgery that many times is unnecessary.

1. Srinivas SV, Deyo RA, Berger ZD Application of “Less Is More” to Low Back Pain. Arch Intern Med. 2012;172(11):1-5. doi:10.1001/archinternmed.2012.18382.
2. Emery et al, Research Letter “Overuse of Magnetic Resonance Imaging” published in the May 15, 2013, issue of JAMA Internal Medicine(2013;173[9]:823-825. doi:10.1001/jamainternmed.2013.3804),
3. 1. Andersen JC. Is immediate imaging important in managing low back pain? J Athl Train. 2011 Jan-Feb;46(1):99-102.
4. Franz EW, Bentley JN, Yee PP, Chang KW, Kendall-Thomas J, Park P, Yang LJ. Patient misconceptions concerning lumbar spondylosis diagnosis and treatment. J Neurosurg Spine. 2015 May;22(5):496-502. doi: 10.3171/2014.10.SPINE14537. Epub 2015 Feb 27.
5. Weiner BK, Patel R. The accuracy of MRI in the detection of Lumbar Disc Containment. Journal of Orthopaedic Surgery and Research 2008, 3:46
6. Madan SS, Rai A,Harley JM. Interobserver Error in Interpretation of the Radiographs for Degeneration of the Lumbar Spine. Iowa Orthop J. 2003; 23: 51-56.