25/01/2022
Imaging for Low Back Pain 🧐
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Do you need to get imaging (e.g., X-ray, CT scan, MRI) if you have low back pain?
SHORT ANSWER:
❌ Mostly no (90‒95% of the time)
✅ Sometimes yes (5‒10% of the time)
LONG ANSWER:
Imaging can help 5‒10% of people with low back pain, where there is a complicated cause (e.g., fracture, cancer, infection, severe nerve issue) 💁♂️
Imaging tends not to be as helpful for the other 90‒95% of people with low back pain (uncomplicated low back pain) 🤷♂️
…… But why not just scan everyone?
‘Unnecessary’ scans can do you more harm than good, for example:
▪️ Unhelpful for diagnosis (you may find ‘changes’ in your spine but they may not be related to your pain)
▪️ Unhelpful for guiding treatment (most changes in your spine do not change your treatment)
▪️ Inappropriate treatment (e.g., unnecessary surgery) and/or delay in appropriate treatment
▪️ Delayed recovery
▪️ Radiation exposure.
Scans often show ‘changes’ in the spine, such as disc degeneration and disc bulges.
However, many changes are common in both people WITH and WITHOUT pain! These changes are also more common as you age, so they are likely normal (similar to grey hair or wrinkles)! 👴🏻👵🏽
🌟 A detailed assessment with your clinician (e.g., physiotherapist) can help to determine if you need a scan or not 👨⚕️👩⚕️ Interestingly, more information is gained from what you tell us rather than what we see on imaging! Scans are not needed for most people with low back pain 🥳
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References:
1️⃣ Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American journal of neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173
2️⃣ Hall, A. M., Aubrey-Bassler, K., Thorne, B., & Maher, C. G. (2021). Do not routinely offer imaging for uncomplicated low back pain. BMJ (Clinical research ed.), 372, n291. https://doi.org/10.1136/bmj.n291