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Chiropractic Research Review

Radiographs More Reliable Than Rapid MRI for Diagnosing LBP

Proponents of rapid magnetic resonance imaging (MRI) suggest it can enhance the care of patients with low back pain (LBP) by providing faster definitive diagnosis and eliminating the need for further diagnostic examination.

However, it remains unknown whether rapid MRI scanning actually results in better patient outcomes than standard radiographic evaluation. One problem with rapid MRI is that more incidental findings are visualized than with conventional radiographs, which may lead to unnecessary surgery. For example, disc herniations are seen in about one-third of patients and disc bulges are visualized in one-half to two-thirds of patients without LBP.

In a study designed to determine "the clinical and economic consequences of replacing spine radiographs with rapid MRI for primary care patients," researchers recruited 380 patients with LBP from four imaging centers in western Washington state. All patients had been referred for imaging by their primary physician. Patients completed questionnaires on pain and functional status, then were assigned randomly to receive lumbar spine evaluation by rapid MRI or X-ray.

Outcome measures included the modified Roland Back Pain Disability Scale (conducted 12 months following randomization); back pain frequency and irritation; the Short Form-36 health questionnaire; days of reduced or lost work; patient satisfaction with care; and reassurance and preference scores. Econonic analysis was based on reviews of patient diaries and medical and billing records.

Replacing lumbar spine X-rays with rapid MRI scans led to no long-term differences in disability, pain or general health status. Although more patients and physicians preferred rapid MRI, there were indications that MRI also contributed to higher rates of surgery (10 patients in the MRI group vs. 4 patients in the X-ray group) and higher overall societal costs at one-year follow-up ($2,380 for MRI vs. $2,059 for radiographs). However, these cost differences were not statistically significant.
The study authors note these potential shortcomings in their conclusion: "We recommend that rapid MRI not become the first imaging test for primary care patients until its consequences for surgical rates and costs are better defined."

Jarvik JG, Hollingworth W, Martin B, et al. Rapid magnetic resonance imaging vs. radiographs for patients with low back pain. Journal of the American Medical Association, June 4, 2003:289(21), pp2810-18. http://jama.ama-assn.org/

Chiropractic Research Review

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