Low Back Pain & MRI

By Andy Parsons, PT, DPT

MRI is frequently utilized for assessing people with low back pain. Should it be? There are at least a few recent studies that question an MRI's utility in LBP patients. A study of people without low back pain found that 80% of people by age 50 have degenerative disc disease.  In the same group, 50% had a disc bulge by age 40.(1) These findings have traditionally been considered "abnormal" Could it be many of these findings are really just a normal part of aging? Probably...

MRI may not be the "Gold standard" it was once thought to be. One study linked early MRI to an 8x increased rate of spine surgery (2). 

Should we stop MRI completely for back pain? No,BUT people do need to be educated that MRI results are not the "end-all-be-all" for diagnosis, management, and prognosis. "Conservative" care, including physical therapy, needs to be trialed first before surgery is considered in most cases. The average outcomes are better with guideline adherent care and early physical therapy costs the healthcare system less money (3,4).

Should surgery be an option? Yes! But only after good faith efforts in PT, & appropriate medical management.  

Thoughts?

 

Addendum 8/22/15:

I've decided to include the table from the study so you can assess image finding patterns more easily for yourself. The number of subjects in this systematic review was 3110.

  Brinjikji et al. www.dx.doi.org/10.3174/ajnr.A4173

  Brinjikji et al. www.dx.doi.org/10.3174/ajnr.A4173


References:

1. Brinjikji, W., et al. "Systematic literature review of imaging features of spinal degeneration in asymptomatic populations." American Journal of Neuroradiology 36.4 (2015): 811-816.

2. Webster, Barbara S., and Manuel Cifuentes. "Relationship of early magnetic resonance imaging for work-related acute low back pain with disability and medical utilization outcomes." Journal of Occupational and Environmental Medicine 52.9 (2010): 900-907.

3. Childs, John D., et al. "Implications of early and guideline adherent physical therapy for low back pain on utilization and costs." BMC health services research 15.1 (2015): 150.

4. Fritz, Julie M., Gerard P. Brennan, and Stephen J. Hunter. "Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges." Health services research (2015).

**  This information is not intended to replace the advice of a physician/ physical therapist. Andy Parsons, PT, DPT disclaims any liability for the decisions you make based on this information.