To Scan, or Not To Scan

How getting a scan impacts our approach to getting better.

Our page on disc pathologies looks at the evidence that structural issues such as herniated and prolapsed discs may not be the cause of chronic lower back pain. This article will summarise further research which suggest that MRI scans may result in poorer outcomes for back pain patients.

MRICartoonTwo separate studies reviewed the treatment outcome of back pain populations, identifying;

  • Whether having an MRI improved the positive recovery of patients
  • Where early MRI scans actually led to worse patient outcomes.

These studies reviewed data from thousands of back pain patients, categorising people into two groups. The ‘high propensity’ group were patients in worse condition. The case presentation of these patients usually led to the doctor ordering a scan. The ‘low propensity’ group condition was better, so the doctor generally did not order a scan.

From these two groups, two interesting sub-groups emerged;

  1. High propensity but no scan: These patients case presentation would suggest that most doctors would order a scan, but for whatever reason they didn’t.
  2. Low propensity but scanned: These cases would normally not be scanned, but they were.

ProlapsedDiscIllustration

The results?

Patients with high propensity, no scan had significantly better outcomes. They took 200% less disability days compared to their scanned brothers.

Shockingly the low propensity scanned group had significantly worse outcomes. Compared to the majority of unscanned low propensity patients, there was a significantly higher rate of surgical intervention. Lets clarify this; two patients present with similar, non-serious back pain cases. The patient who gets a scan is significantly more likely to have surgery than the non-scanned patient.

Logically it makes sense

If the majority of back pain cannot be attributed to disc pathology (click here to read more on this) than having a scan wont change treatment outcomes. But if you do get a scan which highlights structural issues; you are likely to assume that this causes your back pain. Since major structural issues in the spine cannot be reversed (you cant un-herniate/un-prolapse a disc) without surgery, you assume that your back pain cannot be fixed without surgical intervention. As we highlighted in our previous posts however, disc pathology is rarely the cause of lower back pain.

Are MRIs bad? Where to from here.

Obviously MRIs aren’t bad, and are clearly needed in certain cases. However the above studies suggest that more information is not always better. Unless you have serious symptoms such as a loss of motor control, numbness etc. (outlined here) and you’re on the fence, an MRI may not improve you’re recovery outcomes.

 

References

Jarvik JJ, Hollingworth W, Heagerty P, Haynor DR, & Deyo RA (2001). The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) Study: baseline data. Spine, 26 (10), 1158-66 PMID: 11413431

Kalichman L, Kim DH, Li L, Guermazi A, Berkin V, & Hunter DJ (2009). Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine, 34 (2), 199-205 PMID: 19139672

Webster BS, & Cifuentes M (2010). 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 / American College of Occupational and Environmental Medicine, 52 (9), 900-7 PMID: 20798647

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