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Excessive MRIs and Excessive Low Back Surgeries?

Evidence based practice

A recent research study published in the October, 2009 issue of Health Affairs concluded that people with low back pain, that live in more densely populated areas (cities over rural areas), are more likely to have an MRI and are also more likely to have back surgery.

Curiously enough, a major factor that determines whether an MRI test will be ordered for non-specific low back pain (NOTE: non-specific low back pain is pain only in the back that may or may not radiate down into the buttock and/or thigh but not below the knee), is access or availability.

Furthermore, if you have an MRI for your non-specific low back pain, there is a greater chance that you will have low back surgery. At first glance, it may seem to make sense but here's the problem:

For non-specific low back pain, MRI very, very rarely provides any information that could help your doctor decide if you are appropriate for surgery. In other words, MRIs just aren't the right test to order for non-specific low back pain. In most cases, they don't provide useful information.

Quoting the press release from the Stanford University research group that performed this study:

  • "Two-thirds of the MRI scans that appear to result from increased availability happened within the first month of onset. Clinical guidelines recommend delaying MRI use until four weeks after onset..."
  • "The big issue is how we handle new and exciting technologies in ways that allow us to reap the benefits of medical advances, without letting all of our new things generate waste or, worse, actual reductions in patient well-being,"
  • John Birkmeyer, MD, said, "… the research confirms fears that greater access to MRI technology leads to more back surgeries. 'The net result is increased risks of unnecessary surgery for patients and increased costs for everybody else,' ".

Take home message is that if you have non-specific low back pain, more often than not, an MRI and surgery is unnecessary.

A trip to a physical therapist is usually most appropriate for non-specific low back pain. Clinical studies on acute low back pain treatment conclude that proper hands-on care can help you feel better faster.
Reference: Jacqueline D. Baras and Laurence C. Baker. Magnetic Resonance Imaging And Low Back Pain Care For Medicare Patients. Health Affairs Web Exclusive, October 14, 2009

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