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May 10, 2019

In 2015 Brinjikji et al. performed a follow-up study on the association between radiological findings (X-ray, MRI etc.) and patients experiencing low back pain. Earlier in 2015 Brinjikji published a study citing a lack of relationship between imaging and back pain with some notable limitations. The primary limitation of this study was that ALL the participants in it were asymptomatic.

In his follow up study data from over 3000 people under the age of 50 years old were analyzed. The goal was to see whether imaging could predict painful backs.

This has become a hot topic within back pain as to whether or not you need an MRI or x-ray as a patient. There is a large discussion happening in medicine where imaging is seen as less telling towards the overall prognosis of how well a patient does. Furthermore, the debate continues as to whether imaging is even necessary for patients at all.

The results of this meta-analysis concluded that when comparing asymptomatic vs. symptomatic populations MRI changes and painful backs were reasonably associated.

Conditions with the strongest associations were disc bulge (5.9%/43.2%), disc degeneration (34.4%/57.4%), disc protrusion (19.1%/42.2%) and Modic changes (12.1%/23.2%). So what does all this mean? If your back is painful, is an MRI necessary?

One limitation of this study is that back pain was very broadly defined. As you can imagine the intensity, frequency, and disability of back pain can vary significantly across anyone 50 years and younger. Secondly, “degeneration” was not graded in this study, which meant all osteoarthritis was discussed under one lense.

My take away from this is maybe imaging matters more than we think in certain cases. As always, it depends, I wouldn’t suggest everyone should now run requesting MRIs, but they may play a role in the long term success of a patient.

This may be particularly true where the MRI changes and patient presentation match up. Have you had an MRI for your back pain? Was anything changed in your treatment plan as a result of your imaging? Let me know in the comments below.

SOURCES:
Brinjikji et al. (2015) MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol, 36, 12, 2394-9. doi: 10.3174/ajnr.A4498

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