Low Back Pain and a MRI

A MRI is frequently used to help diagnose problems in people with low back pain. Should it be? Recently there have been a few studies that question an MRI’s utility in patients with low back pain. One study of people without low back pain found that 80% of people, by age 50, have some level of degeneration in the inter-vertebral disks.

mri-300x236In the same study, 50% had some sort of disc bulge by age of 40. Traditionally, these findings would have been considered “abnormal”. In reality, these findings are really just a normal part of aging. MRI is probably not be the “Gold standard” it was once thought to be with regards to low back pain. Another recent study linked early MRI to an 8x increased rate of spine surgery. It has been widely regarded that a MRI is only about 80% indicative of the true problem.

Should we stop using MRI’s to assist in the true diagnosis of low back pain? No, not all together, BUT people do need to be educated that MRI results are not the “magic bullet” for diagnosis, management, and prognosis. Conservative care, which includes physical therapy, needs to be tried first before surgery is considered in most cases. Studies show that physical therapy first, for many injuries ranging from neck pain to an ankle sprain, will provide improved outcomes to the patient. The average outcomes utilizing early physical therapy costs the healthcare system, and the patient, less money and a quicker return to their prior level of function.
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.

Andrew Vertson