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Should I get an MRI?

Should I get an MRI?
March 19, 2016 Dr. Phillip Snell

Does MRI Show What's Wrong?

should-i-get-an-mriSince its advent in modern healthcare in the late 1970s, magnetic resonance imaging (MRI) has been the darling of diagnosticians seeking a better way to identify causation of low back pain.  Unfortunately, the promise of MRI to definitively diagnose common lumbar pathology has been disappointing. Additionally, the high cost of MRI has placed it firmly in the crosshairs of those attempting to reduce skyrocketing health care costs due to unnecessary procedures. (1)  As it turns out, MRI gave us a different vantage point on lumbar pathology which has taken a bit longer for us to learn how to behave responsibly with. Much of the putative pathology which has driven surgical interventions in the past we now know occurs in asymptomatic folks with no back pain. Here at FixYourOwnBack, we prefer to view MRI as useful in demonstrating a process that might be in play at the lumbar disc rather than a pathology that is set in stone.  It’s important to note that there are simple, low cost and easy to learn interventions which can help a person interrupt that process and begin to heal the disc.

A left over from the early days of MRI use is a perception by many patients with back pain and and sciatica that MRI is needed to know “what’s wrong”. As a result patients will often push for an early MRI to determine whether they have injury to the lumbar discs. As it turns out, a well performed cluster of tests in the clinic and a well performed history by your doctor are all that is needed in the early stages to determine the best course of action in your treatment plan. (2,3)  Some studies have pointed out that early use of MRI in back pain cases results in increased surgical interventions, and overall higher costs with absolutely no improvement in outcomes. (4) These days, the standard of care is to first intervene with conservative procedures. That care may consist of exercise interventions from a physical therapist or chiropractor, passive pain management from those professionals, or from a massage therapist or acupuncturist. Possibly a “wait and see” period might be suggested and the person will receive re-assurance and recommendations to stay active. Primary care physicians may prescribe pain medication and muscle relaxants for a short period, as well. Interestingly, the often touted McCullough study showed that when people receive an MRI and are also given the epidemiology evidence showing that many people with similar findings are asymptomatic, a distinct drop in use of pain medication is noted. (5)

If those interventions don’t work quite as well to help manage pain then MRI might be warranted to help inform the next level of intervention which might be epidural steroid injections or possibly surgery.  But if you’re not at that stage yet, give the conservative route an opportunity before pushing your doctor for an MRI. If your doctor suggested an MRI very early before conservative care, then point them to this article. Our next article will discuss whether surgery is the best course of action with lumbar disc injury as well. In the meantime you can consider using FixYourOwnBack.com as an information and exercise resource to help self manage your sciatica and disc injury.

References

1. http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande

2. Majlesi J, Togay H, Unalan H, Toprak S. The sensitivity and specificity of the Slump and the Straight Leg Raising tests in patients with lumbar disc herniation. J Clin Rheumatol. 2008 Apr;14(2):87-91.

3. van der Windt DA, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, Devillé W, Deyo RA, Bouter LM, de Vet HC, Aertgeerts B. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev. 2010 Feb 17;(2)

4. Jarvik JG, Gold LS, Comstock BA, Heagerty PJ, Rundell SD, Turner JA, Avins AL, Bauer Z, Bresnahan BW, Friedly JL, James K, Kessler L, Nedeljkovic SS, Nerenz DR, Shi X, Sullivan SD, Chan L, Schwalb JM, Deyo RA. Association of early imaging for back pain with clinical outcomes in older adults. JAMA. 2015 Mar 17;313(11):1143-53.

5. McCullough BJ, Johnson GR, Martin BI, Jarvik JG. Lumbar MR imaging and reporting epidemiology: do epidemiologic data in reports affect clinical management? Radiology. 2012 Mar;262(3):941-6.