Don’t perform magnetic resonance imaging (MRI) of the spine within the first six weeks in patients with low back pain in the absence of warning signs or symptoms (red flags).

Don’t perform magnetic resonance imaging (MRI) of the spine within the first six weeks in patients with low back pain in the absence of warning signs or symptoms (red flags).

Type of practice

Imaging

Age

Adult, Geriatric

Topic Area

Medical Radiology

Usually MRI is prescribed at the first complaint of back pain and sciatica, without performing a first-line conservative treatment with both pharmacologic and nonpharmacological (e.g., exercises, remaining active) therapy. In the absence of serious neurological or systemic symptoms, lumbosacral MRI for both acute and chronic lower back pain and sciatica is not routinely recommended, but should be considered only if there are persistent or progressive symptoms during or following 6 weeks of conservative treatment.
If MRI shows no pathological findings it should not be repeated within 24months.In the absence of red flags (such as cord compression or spinal cord injury) in patient history or physical examination, an MRI or other imaging techniques in the first six weeks, usually don’t modify the therapeutic approach but could lead to incidental findings, to perform other unnecessary examinations or surgery, or to ionizing radiation exposition; all representing a high cost for society.

Sources

1. Hendee WR, Becker GJ, Borgstede JP et al. Addressing overutilization in medical imaging. Radiology 2010; 257:240–245.
2. Sistrom CL. The appropriateness of imaging: a comprehensive conceptual framework. Radiology 2009;251(3):637–649.
3. Oikarinen H, et al. Survey of inappropriate use of magnetic resonance imaging. Insights Imaging. 2013 Oct;4(5):729-33.
4. Chou R, Loeser JD, Owens DK, et al. American Pain Society Low Back Pain Guideline Panel Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Spine.2009;34:1066–1077.
5. Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR. The RAND/UCLA Appropriateness Method: Users Manual. 2001.
6. Pompan DC Appropriate use of MRI for evaluating common muscoloskeletal conditions. Am Fam Physicians 2011;83 (8): 883-884.
7. Andersen JC Is immediate imaging important in managing Low Back Pain? Journal of Athletic Training 2011; 46(1):99–102.
8. Webster BS et al. Iatrogenic consequences of early Magnetic Resonance Imaging in acute, work-related, disabling Low Back Pain. SPINE 2013; 38(22): 1939 – 1946.
9. Tonosu J et al. The associations between Magnetic Resonance Imaging findings and low back pain: A 10-year longitudinal analysis. PLoS ONE 2017; 12(11): e0188057. https://doi.org/10.1371/journal.pone.0188057 .
10. Rajasekaran S et al. The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting’: results from an RCT and blinded trials. European Spine Journal 2021; 30:2069–2081.

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Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.