New Research on MRI and back pain treatment recommendations

Category: Back Pain, Blog

A new study found that  a surprisingly high percentage of patients have misconceptions regarding the diagnosis and treatment of lumbar spondylosis – degenerative changes such as osteoarthritis in the spine.

What were these misconceptions? Specifically, patients overemphasize the value of radiological studies and have mixed perceptions of the relative risk and effectiveness of surgical intervention compared with more conservative management.

In short: The MRI will tell the doctors what surgery to perform and all will be well. 

Worse, more than 50% of the patients indicated that they would undergo spine surgery based on abnormalities found on MRI, even without symptoms.1

MRI-with-patient-and-doctor[1]Patient goes into the doctor’s office, past complaints of back pain. The pain may come and go. An MRI reveals slipped, herniated, bulging discs, based on the MRI film, a surgery is ordered.

Recently researchers found that not only do doctors have an over-reliance on MRIs in suggesting treatment or surgery for patients BUT – the MRI may be leading doctors down the wrong path in offering future treatment guidelines. 2 Further, that doctors are frequently requesting MRIs for for weak or various reasons that may not reveal the true cause of the patient’s discomfort. 3

These research papers agree – an MRI for back pain maybe the wrong path.

But how is the MRI the wrong path? Doctors looked at the top 100 cited medical research papers on back pain. The number one and number two articles were articles on how doctors tried to explain the peculiar problem of why a patient has no symptoms or pain but their MRI suggests extensive spinal abnormalities including herniated discs.4 These are the same problems studied in the citations above. Obviously this is a point of great concern for doctors, what to do with an MRI reading that shows something on film but not in the patient.

Unnecessary surgery even in the presence of pain

There are many things that can cause spinal instability and back pain. The MRI shows a disc problem, but it may not show ligament strain or sprain. It may not show muscle spasms. Soft tissue injury can cause significant pain and instability while the herniated disc causes no pain, but if captured on film – will send the patient off to a surgical recommendation and a date for fusion or other procedure.

They did some research at Columbia University that confirmed the problems of MRI “of 274 patients seen in consultation in a single year, 45 were scheduled for “unnecessary surgery.” Further, while these patients did experience pain, a vague MRI sent them for a surgery while there “was no clear surgical procedure that would benefit the patient.” 5

In other research it was noted that MRI alone may provide insufficient or inaccurate information upon which to base surgical/technical decisions in about of 30% of cases.6

Simply, if the back surgery is not addressing the true cause of the pain, then that pain will not be healed and the patient will have to be subjected to a surgery that could lead to significantly more pain.

Research like that above may confirm what many already know. The reason a back surgery will fail to provide relief is that the patient agreed to receive the wrong treatment.

Making the situation worse is now there is a need for a “revision” surgery. A second or their surgery to fix the first surgery.

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1. 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.

2. Steffens D, Hancock MJ, Maher CG, Williams C, Jensen TS, Latimer J. Does magnetic resonance imaging predict future low back pain? A systematic review. Eur J Pain. 2013 Nov 26. doi: 10.1002/j.1532-2149.2013.00427.x. [Epub ahead of print]

3. Balagué F, Dudler J. [Imaging in low back pain: limits and reflexions]. Rev Med Suisse. 2013 Jun 26;9(392):1351-2, 1354-6, 1358-9.

4. Steinberger J, Skovrlj B, Caridi JM, Cho SK. The top 100 classic papers in lumbar spine surgery. Spine 2015 May 15;40(10):740-7. doi: 10.1097/BRS.0000000000000847.

5. Epstein NE, Hood DC. “Unnecessary” spinal surgery: A prospective 1-year study of one surgeon’s experience. Surg Neurol Int 2011;2:83

6. Weiner BK, Patel R. The accuracy of MRI in the detection of Lumbar Disc Containment. Journal of Orthopaedic Surgery and Research 2008, 3:46