5 Things To Consider Before Getting An MRI/X-ray

While each individual's experience with low back pain is unique, you are not alone. At this very moment 540 million people on the planet are experiencing low back pain. This pain is limiting many from activities they love and need to do.


And often it comes with a couple of questions:


What is the cause of my low back pain and how do I fix it?


Should I get an MRI or X-Ray?


Here are 5 things you should consider before getting imaging:


1. Guidelines

It is the recommendation of the American Chiropractic Association, American College of Physicians, North American Spine Society and the American Pain Society that lumbar imaging (both X-Ray and MRI) be utilized only in those whose care would change based on the results.

Specific conditions they outline that would change care management:

  • Spinal fractures (1.8-4.3%)

  • Malignancy/Cancer (.2%)

  • Infection (0.01%)

  • Cauda equina Syndrome (0.04%)

Red flags possibly indicating these include:

  • Medical History (trauma/fall, history of cancer, extended corticosteroid use)

  • Extreme sensation changes in the legs

  • Significant/sudden decreases in leg reflexes and strength

  • Bowel bladder control changes

All of these rare instances that SHOULD be considered for lumbar imaging contribute to less than 5% of cases, yet in America 54% of patient’s not demonstrating any of these red flags are sent to imaging.


2. Normalcy


It’s normal for your lower back to show degeneration and seeing this does not mean it's the cause of your pain.


When 3,110 PAIN FREE individuals had imaging performed, a lot of the things one would normally see as the culprit of pain were found. Disk Degeneration in 37% of 20 years olds up to 96% of 80 years olds. Disc Bulges in 30% of 20 year olds up to 84% of 80 year olds. Disc protrusions in 29% of 20 year olds up to 43% of 80 years olds. And so much more.

.

The conclusion? “The imaging findings of degenerative changes are generally part of the normal aging process rather than pathological processes requiring intervention.”


Spinal changes on imaging seem to be the equivalent of gray hair and wrinkles.


3. Accuracy



All readings of imaging are not treated equally as one would think. Who you have read your MRI matters.


One 63 year old woman with low back pain and leg pain to her foot had 10 different MRI’s at 10 different locations in a 2 week period. Between the 10 images, 49 different “abnormalities” were found. Yet none of the 10 studies had all of these abnormalities, and only 1/3 of the findings were consistent across all 10.



In another study, 5 radiologists were tasked with identifying “abnormalities” in lumbar imaging in 53 patients with low back pain. The average agreement between radiologists 41-60%.


The chances of consistent imaging readings could be less than that of a coin toss.



4. Outcome


Get a look under the hood, find the problem, fix the problem. Simple for cars, not so much for humans.


In a 2 year follow up of 3,264 cases of low back pain. Those who got imaging outside of the guidelines, were more likely to have WORSE outcomes, INCREASED disability, and increased surgery and injections.

5. Cost


The cost of getting imaging comes in 2 forms: income loss and medical bills.


Potential earnings in missed work days. In a study of those Those who got early imaging missed an average of 133.6 work days over a 2 year period. Those who didn’t receive imaging only missed an average of 22.9 days


For those who get imaging first, outside of the cost of the actual imaging, adding the increased use of surgery, injections, and in medical visits racks up the cost. Compared to individuals who chose to see a physical therapist first, those who got imaging spent on average $4,793 more over the course of their care and recovery.

What Should I Do Now?

Imaging has its place in the treatment of low back pain, but we are learning that the role it plays is becoming smaller and smaller despite its continued overuse. While the decision to proceed with imaging should be an individual one, it should be an informed one as well.

If low back pain has made it hard to be a full participant in your life we recommend following up with your local physical therapist.

If you are near the Mounds View, MN area we would love to help you! As Doctors of Physical Therapy we will give you a comprehensive evaluation and an individualized treatment plan that will get you back to being you in no time at all.

We facilitate rapid pain relief with skilled hands-on techniques and exercise prescription, based on actual strength and conditioning principles from today’s cutting edge clinical research.

Our 3 stage approach is designed to give you the most efficient progress:

  • FIND: Eliminate the guesswork with a thorough evaluation

  • FIX: Get the pain under control quickly with precise care

  • FACILITATE: Create long term, sustainable change

References:


Arana E, Royuela A, Kovacs FM, et al. Lumbar Spine: Agreement in the Interpretation of 1.5-T MR Images by Using the Nordic Modic Consensus Group Classification Form. Radiology. 2010;254(3):809-817.


Brinjikji W, Luetmer PH, Comstock B, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology. 2015;36(4):811-816.


Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. Oct 2 2007;147(7):478-491


Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet. 2018;391(10137):2368-2383.


Graves JM, Fulton-Kehoe D, Jarvik JG, Franklin GM. Early imaging for acute low back pain: one-year health and disability outcomes among Washington State workers. Spine . 2012;37(18):1617-1627


Herzog R, Elgort DR, Flanders AE, Moley PJ. Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period. Spine J. Apr 2017;17(4):554-561


Webster BS, Cifuentes M. 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. 2010;52(9):900-907.



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