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


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 or 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 24 months.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.


1. Hendee WR, Becker GJ, Borgstede JP et al (2010) Addressing overutilization in medical imaging. Radiology 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 D.C. Appropriate use of MRI for evaluating common muscoloskeletal conditions Am Fam Physicians 2011; 83 (8): 883-884.

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.