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My Spine Hurts…Do I Need an MRI?

My Spine Hurts…Do I Need an MRI? 

Magnetic Resonance Imaging (MRI) is a widely used diagnostic test for a variety of health problems. It utilizes electromagnetic energy to produce images of body tissues and organs that provide a level of detail not found with other standard imaging tests. Because it does not involve the use of ionizing radiation, it does not carry the same risk as x-ray and CT scans. Its use in diagnosing low back and neck pain has grown substantially over the past 30+ years.

Along with the increased utilization of MRI, there has been an increase in the cost of managing spine related complaints. Although there are many other factors involved in exponential cost increases for managing spine pain, MRI has certainly contributed its share.

So this begs the question: has MRI improved the treatment outcomes for spine pain? According to recently published research (Steffans D et al, 2015), the short answer is no. Or at least, there is little evidence that it has.

What is becoming more evident is that oftentimes, MRI reveals “pathological” changes that are really age-related changes that have nothing to do with your pain. There have been numerous studies demonstrating that these types of changes, such as disc degeneration, occur frequently in people that have no symptoms. For example, 52% of 30 year-old people without symptoms of back pain will have disc degeneration; fully 96% of 80 year-old people without symptoms will have disc degeneration.

Clinical guidelines for use of MRI are clear that in most cases of spine pain, MRI is unnecessary. It should be used only when more serious problems are suspected based upon the patient examination. In cases of persistent pain – pain lasting more than 6 weeks – MRI should be used only if surgery or other invasive treatments are being considered.

The majority of people, by far, that experience spine pain are managed effectively by conservative healthcare providers like physical therapists. So if you have low back or neck pain, consider seeing your physical therapist first. New York State allows for direct access to physical therapists and most insurance plans cover physical therapy services.

 Marcia Spoto PT, DC, OCS

ˇWˇ"; mso-bidi-font-family:"\@>ˇWˇ";color:#000050">*Steffens D et al. Do MRI findings identify patients with low back pain or sciatica who respond better to particular interventions. European Spine Journal. 2015. DOI 10.1007/s00586-015-4195-4

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