This is a brief post about the relationship between MRI findings and low back pain.
It is being written because of similar questions and concerns I have had from several of my low back pain recovery clients over the last few weeks.
If you would like to discuss this further click HERE to arrange for a free, personal “Discovery Call” where I will go over what this means to you in more detail and also give you an idea of the unique type of help I offer to the clients working with me.
One of the most important things you need to know when you are suffering with low back pain is this.
In most cases, there is NO relationship between what is seen on your low back MRI, your current pain, or your risk of experiencing low back pain in the future.
Here is what one of the studies shown below found when researching this:
When following 131 people over a 3 year period, the incidence of of low back pain was 67%.
People experiencing depression had a 2.3 times greater risk of having low back pain as compared to those not suffering with depression.
There was no association between abnormalities found on lumbar MRI’s (such as disc degeneration, annular tear, and facet arthropathy) the risk of experiencing current pain or pain over a 3 year period.
At the end of the 3 year period, 11 people showed an increase in the extent of lumbar disc degeneration. Those 11 people had no greater risk of low back pain when compared to the others.
However, over 3 years, lumbar disc extrusions were found in 5 people, and the presence of this finding WAS associated with an increased risk of back and/or sciatic pain.
One of the BIGGEST mistakes that many of you make is basing your diagnosis, and even more importantly, your low back pain treatment choices solely on what is seen on your lumbar MRI.
Doing so can work against you in many ways. Consider the following:
Up to 30% of the lumbar MRI’s performed may be ordered inappropriately (1)
A different study found that only 44.3% of the lumbar spinal MRIs were deemed appropriate, 28.5% were inappropriate, 27.2% were of uncertain value and that Family physicians had the worst track record with only 33.9% of their MRI scans considered necessary. (2)
When combining numerous other studies of lumbar MRI on a group of asymptomatic people over age 45, one would find 64% showing a bulge, protrusion, herniation, or sequestration and 50% showing some grade of disc degeneration. The risk of future back pain in these asymptomatic people did not depend on what was found on imaging. (3,4,5)
It has also been shown that early use of imaging leads to a greater likelihood of surgery, higher costs, and a no better outcome as compared to cases where imaging and/or surgery was not performed. (4,6)
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References
1. Emery DJ, Shojania KG, Forster AJ, Mojaverian N, Feasby TE. Overuse of Magnetic Resonance Imaging. JAMA Intern Med. 2013;173(9)
2. Lurie JD, Birkmeyer NJ, Weinstein JN. Rates of advanced spinal imaging and spine surgery. Spine 2003;28:616 –20.
3. Boden SD et al. Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects: A prospective investigation. J Bone Joint Surg Am 1990; 72A:403-40
4. Jarvik JJ, et al. The longitudinal assessment of imaging and disability of the back. Spine 2001;26: 1158-66.
5. Masui T, et al. Natural History of Patients with Lumbar Disc Herniation Observed by Magnetic Resonance Imaging for Minimum 7 Years. J Spinal Disord Tech. 2005 Apr;18(2):121-126.
6. Gilbert FJ, Grant AM, Gillan MG, et al. Low back pain: influence of early MR imaging or CT on treatment and outcome–multicenter randomized trial. Radiology 2004;231:343