Magnetic Resonance Imaging....and Lower Back Pain Diagnosis?

Hey to all and Happy new year 2012!

Is Magnetic Resonance Imaging(MRI) very popular nowadays for lower back pain(LBP) diagnosis? It happens that in Cyprus unfortunately, MRI usage for diagnostic purposes is very common. Most orthopedics are prescribing MRI's for diagnosis, not only for LBP but to diagnose other pathologies.


utsouthwestern.edu

As Flynn et al. 2011depict in the research article Appropriate Use of Diagnostic
Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May
Do as Much Harm as Good, an MRI and other diagnostic tools can be unnecessary most of the times and can have a negative effect on the patient.

Key points summarized from the article:

1. 3 key recommendations for diagnostic imaging (MRI's, CT scans etc.) are: clinicians should not recommend diagnostic imaging to non-specific LBP, diagnostic imaging must be performed only if severe or progressive neurological disorder is present and clinicians should use diagnostic imaging in evaluating persisting LBP.
2. History of cancer with new onset of LBP, vertebral infection, cauda equina syndrome and progressive motor weakness are the 4 major serious pathologies (red flags) that need an MRI investigation.
   
3. Imaging should not at all times guide therapeutic decision making.
4. Early imaging cannot identify a precise cause most of the times
   
5. MRI can facilitate “medicalization”of LBP, due to pathoanatomy.
   
6. Increased risk of surgery and labeling patients can derive from over-imaging.
   
7. Imaging is harmful to health due to radiation.
   
8. Telling patients that have an“imaging abnormality” has negative effects.
   
9. Physical therapy is an efficient method of diagnosing LBP disorders.
   
10. Appropriate imaging and the integration of the imaging findings in the overall context of patient’s function and disability are essential elements of patient education that physical therapy consist of.

The bottom line.....consider an MRI only if there are major pathologies present and physical therapy is valuable for diagnosis and treatment of LBP. I'm out......