Even though MRI(magnetic resonance imaging) is considered a “gold standard” in evaluating spinal problems it is not perfect. The difficulty with the results of an MRI scan, as with many other diagnostic studies, is that the "abnormality" that shows up on the MRI scan may not actually be the cause of back pain. Numerous clinical studies have shown that approximately 30% of individuals in their thirties and forties have a lumbar disc herniation on their MRI scan, although they do not have any back pain.
Therefore, an MRI scan cannot be interpreted on its own. Everything seen on an MRI needs to be well-correlated to the individual patient’s situation, including:
- Symptoms (such as the duration, location, and severity of pain)
- Any neurological deficits on their physical examination
Another important consideration with MRI scans is the timing of when the scan is done. The only time an MRI scan is needed immediately is when a patient has either:
- Bowel or bladder incontinence
- Progressive weakness in the legs due to nerve damage.
The following general rules are usually considered before ordering an MRI scan for a patient with back pain, neck pain or leg pain stemming from a spine problem.
Indications for when to get an MRI scan include:
- After 4 to 6 weeks of leg and/or back pain, if the pain is severe enough to warrant treatment such as spinal injection or similar intervention
- After 3 to 6 months of low back pain, if the pain is severe enough to warrant surgery and patient did not respond to conservative treatment including spinal injections
- If the back pain is accompanied by constitutional symptoms (such as loss of appetite, weight loss, fever, chills, shakes, or severe pain when at rest) that may indicate that the pain is due to a tumor or an infection
- For patients who have not done well after having back surgery, specifically if their pain symptoms do not get better or get worse.
We do see abnormal MRI findings in patients with no symptoms; in one of the published studies the prevalence of herniated disk was as high as 22% to 36% while study subjects had absolutely no complaints. The opposite is true as well and patients can have spinal pain with normal or inconclusive MRI findings. In this case further worked-up with additional tests including specialized X-ray studies and/or diagnostic nerve blocks would be indicated.
If this described your case you may be best served by being evaluated in the clinic specializing in treatment of the cases similar to yours where your history, x-rays and previous treatments will be carefully reviewed, you will be examined and all available and appropriate diagnostic and treatment options will be presented and discussed.
We specialize in comprehensive management of acute and chronic spinal problems. We invite you to call our office for evaluation and discussion of appropriate treatment.
Author
Vladimir Fiks, MD
Medical Director Advanced Pain Management Center and Cedar Hills Surgery Center
