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).

Oct 17, 2018

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 and environmental harm.

Sources

1. Webster BS, Bauer AZ, Choi YS, et al. Iatrogenic consequences of early Magnetic Resonance Imaging in acute, work-related, disabling Low Back Pain. SPINE 2013; 38: 1939-46. doi:10.1097/BRS.0b013e3182a42eb6.
2. Jenkins HJ, Downie AS, Maher CG, et al. Imaging for low back pain: is clinical use consistent with guidelines? A systematic review and meta-analysis. Spine J. 2018;18:2266-77. doi:10.1016/j.spinee.2018.05.004.
3. Wáng YXJ, Wu AM, Ruiz Santiago F, et al. Informed appropriate imaging for low back pain management: A narrative review. J Orthop Translat. 2018; 15:21-34. doi:10.1016/j.jot.2018.07.009.
4. Rajasekaran S, Dilip Chand Raja S, Thippeswamy Pushpa B, 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; 30:2069–81. doi:10.1007/s00586-021-06809-0.
5. Hutchins TA, Peckham M, Shah LM, et al. ACR Appropriateness Criteria® Low Back Pain: 2021 Update. J Am Coll Radiol 2021; 18; S361-S379. doi:10.1016/j.jacr.2021.08.002.

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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.