15 Min.
Getting an MRI-Scan or X-Ray for Your Back Pain? – Listen to This First! My Back Recovery: Recovering from Chronic Low Back Pain
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- Medizin
- What you should know about MRI and Xray when you have low back pain - Most of typical imaging (making an mri, ct or xray) findings of people with LBP are part of normal aging and are not related to back pain. Using these images to explain your pain without an accurate examination and a carefully guided clinical history interview, is not supported by current scientific evidence!
Clinical guidelines say imaging should be avoided unless signs that raise suspicion for a serious underlying condition like malignancy, spinal fracture, infection of the spine, or cauda equina syndrome are present.1,2,3,4
These signs are usually called 'red flags'. And only a very small percentage of LBP categorises for this group of severe pathology, usually around 1% -> Most people do not show such signs.
Are you having serious disease? (red flags) A potential serious disease is identified by your medical doctor while taking a focused history and looking/listening for so called "red flags". "Red flags are features from the patient’s clinical history and physical examination which are thought to be associated with a higher risk of serious pathology."5 There is no definite list of red flags, but the most commonly used are2:
aged over 50 years old history of cancer steroid use Other commonly suggested “red flags” in clinical practice guidelines are5,2:
faecal incontinence urinary retention widespread neurologic symptoms (could be a palsy, marked weakness of muscles, decreased sensation (feeling numb on your skin), something seriously wrong with your reflexes and your medical doctor will know how to look for that) no improvement in symptoms after one month unexplained weight loss fever being systematically unwell Whilst the use of red flags is recommended by all clinical guidelines there is still little empirical data for its diagnostic accuracy.5,6 If a combination of red flags raises the suspicion of your clinician he or she should assess prognostic factors such as X-rays and blood tests or magnetic resonance imaging to rule out or identify serious disease (malignancy, spinal fracture, infection of the spine, cauda equina syndrome). The so often mentioned slipped disc by itself is not considered a severe pathology!
So why is imaging of your spine not recomended in the absence of red flags?
To put it simple: People with no LBP can have worse mri´s, ct`s or xray´s than people with LBP.
Most of typical imaging findings of people with LBP (such as disk degeneration, disk signal loss, disk height loss, disk protrusion, and facet arthropathy) are part of normal aging and are also present in 90% of individuals 60 years of age or older without even having LBP. Also more than 50% of people without any LBP between 30-39 years of age have disk degeneration, height loss, or bulging in their imaging findings.7
Furthermore no association was identified between findings like spondylolysis, isthmic spondylolisthesis, or degenerative spondylolisthesis, and the the occurrence of LBP.8 No association between lumbar spine facet joint osteoarthritis, identified by multi-detector CT, at any spinal level and LBP.9
Findings on mri are also not predictive of the development or duration of low-back pain.10 Individuals with the longest duration of LBP did not have the greatest degree of anatomical abnormality.11
A recent systematic review concluded that in the acute setting of sciatica (pain radiating down the leg), evidence for the diagnostic accuracy of MRI is not conclusive.12
Let´s put in an example:
If you randomly choose 100 people above 30 years of age that do not have LBP and feel perfectly fine, more than 50 of them will show the typical signs of degeneration that are often (mis)used to explain the cause of LBP.
The same stands true for people with LBP. They too have a good chance to show those signs, but it is just a normal picture, your skin too does not look like the skin of a 10 year old. It´s in most cases a normal
- What you should know about MRI and Xray when you have low back pain - Most of typical imaging (making an mri, ct or xray) findings of people with LBP are part of normal aging and are not related to back pain. Using these images to explain your pain without an accurate examination and a carefully guided clinical history interview, is not supported by current scientific evidence!
Clinical guidelines say imaging should be avoided unless signs that raise suspicion for a serious underlying condition like malignancy, spinal fracture, infection of the spine, or cauda equina syndrome are present.1,2,3,4
These signs are usually called 'red flags'. And only a very small percentage of LBP categorises for this group of severe pathology, usually around 1% -> Most people do not show such signs.
Are you having serious disease? (red flags) A potential serious disease is identified by your medical doctor while taking a focused history and looking/listening for so called "red flags". "Red flags are features from the patient’s clinical history and physical examination which are thought to be associated with a higher risk of serious pathology."5 There is no definite list of red flags, but the most commonly used are2:
aged over 50 years old history of cancer steroid use Other commonly suggested “red flags” in clinical practice guidelines are5,2:
faecal incontinence urinary retention widespread neurologic symptoms (could be a palsy, marked weakness of muscles, decreased sensation (feeling numb on your skin), something seriously wrong with your reflexes and your medical doctor will know how to look for that) no improvement in symptoms after one month unexplained weight loss fever being systematically unwell Whilst the use of red flags is recommended by all clinical guidelines there is still little empirical data for its diagnostic accuracy.5,6 If a combination of red flags raises the suspicion of your clinician he or she should assess prognostic factors such as X-rays and blood tests or magnetic resonance imaging to rule out or identify serious disease (malignancy, spinal fracture, infection of the spine, cauda equina syndrome). The so often mentioned slipped disc by itself is not considered a severe pathology!
So why is imaging of your spine not recomended in the absence of red flags?
To put it simple: People with no LBP can have worse mri´s, ct`s or xray´s than people with LBP.
Most of typical imaging findings of people with LBP (such as disk degeneration, disk signal loss, disk height loss, disk protrusion, and facet arthropathy) are part of normal aging and are also present in 90% of individuals 60 years of age or older without even having LBP. Also more than 50% of people without any LBP between 30-39 years of age have disk degeneration, height loss, or bulging in their imaging findings.7
Furthermore no association was identified between findings like spondylolysis, isthmic spondylolisthesis, or degenerative spondylolisthesis, and the the occurrence of LBP.8 No association between lumbar spine facet joint osteoarthritis, identified by multi-detector CT, at any spinal level and LBP.9
Findings on mri are also not predictive of the development or duration of low-back pain.10 Individuals with the longest duration of LBP did not have the greatest degree of anatomical abnormality.11
A recent systematic review concluded that in the acute setting of sciatica (pain radiating down the leg), evidence for the diagnostic accuracy of MRI is not conclusive.12
Let´s put in an example:
If you randomly choose 100 people above 30 years of age that do not have LBP and feel perfectly fine, more than 50 of them will show the typical signs of degeneration that are often (mis)used to explain the cause of LBP.
The same stands true for people with LBP. They too have a good chance to show those signs, but it is just a normal picture, your skin too does not look like the skin of a 10 year old. It´s in most cases a normal
15 Min.