Low Back Pain and MRI’s
Modern technology has given us many more tools to diagnose disease and associated conditions. One of the struggles that we have in medicine is to determine the use of these and the associated repercussions in doing so. As we go through medical school we are all taught that you only order a test if it affects the treatment options available to the patient. In the real world, it isn’t quite that easy. The medico-legal system has driven up the frequency of tests. Many tests are now done in order to “cover one’s self” instead of actually aiding in the treatment decision tree a patient has available.
MRI’s became available in the 1980’s and became more widespread in the 1990’s. An MRI is an amazing visualization tool because it shows anatomy detail so clearly. Thus, they are widely utilized. It is estimated that there are around 28 million MRI’s performed in the United States annually. But are they overused? Is having an MRI that beneficial? When do you order one? Technology, such as this, is not the cure-all that some think.
A nice article was written in the JOEM (Volume 52, Number 9, Sept. 2010) that addressed the use of MRI’s for work-related low back pain. They studied the use of an early MRI (within 30 days) of a low back work-related injury versus a later MRI or no MRI at all. Interestingly, the group that had early MRI’s was more likely to have prolonged disability, higher medical costs and greater utilization of surgery. They also ended up with a higher then expected rate of having another MRI later on in treatment. MRI’s tend to find abnormalities that are seen, but may not have anything to do with the patient’s condition, leading to more treatment. Most people will get some mild degenerative changes or mild disc disease over time, but that doesn’t mean that it is actually causing them pain. MRI’s don’t always make the situation clearer.
Now, there are certain “red flags” that physicians look for with low back injuries that do necessitate an urgent MRI, but those individuals were not included in this study. What this study does is help show that early MRI’s for work-related low back injuries are generally not that helpful and, in fact, can be somewhat detrimental. Fortunately, 90-95% of people with low back injuries are back to baseline at 6 weeks with just conservative care (which could consist of medication, restricted activity, therapy, etc…).