Imaging for Low Back Pain Largely Unnecessary According to New Recommendations.

imaging for spinal stenosisImaging is unnecessary for lower back pain in most cases according to new research. Patients with back pain lasting less than six weeks should not have imaging such as MRI or X-Ray carried out unless red flags are present such as bowel or bladder dysfunction which can indicate cauda equina syndrome. Imaging may reveal conditions such as spinal stenosis but many people have evidence of spinal stenosis and remain asymptomatic; it is easy to see, therefore, why there are concerns over the prevalence of imaging for lumbar spine pain.

The new recommendations come courtesy of the National Physicians Alliance and their Promoting Good Stewardship in Clinical Practice campaign; recent research from the University of Connecticut Health Center supports this view. Can early imaging of low back pain actually be harmful as well as unnecessary? Should you have an MRI to find out if your acute back pain is due to spinal stenosis?

Are MRIs Necessary?

This recent analysis of the literature around imaging studies for low back pain was performed by Dr. Srnivas, et al, from the Department of Medicine at the University of Connecticut, Farmington. Their data included thirty years of records of clinical guidelines that showed that most cases of lower back pain resolved themselves with little intervention by physicians. They emphasise the need to choose wisely when considering the use of expensive, and sometimes stressful, techniques such as MRI scans and X-Rays for patients with lumbar spine pain. Severe symptoms of spinal stenosis clearly warrant such imaging in order to determine the location and extent of spine degeneration or trauma and to aid surgeons should back surgery be deemed necessary.

MRI_spine necessary

Less is More

Published last year, the NPA’s ‘Top 5 Health Care Activities for Which Less is More,’ included the recommendation to avoid early imaging for low back pain. Such imaging is common for low back pain with 42% of patients with back pain undergoing radiography, for the most part, or other type of imaging within a year of pain beginning (Ivanova, et al, 2011). Another study determined that lumbar imaging for back pain without any sign of serious underlying conditions had no benefit for clinical outcome.

No Benefit to Early MRI?

The cost of back pain in the US is already staggering and Srnivas and colleagues predict that almost $300 million a year could be saved by reducing imaging for low back pain. This is estimated on the basis of restricting the use of imaging to patients with severe indications of neurological deficits or other condition, and for those whose pain is ongoing (over six weeks). Whilst early imaging may make patients feel better emotionally the study concluded that there was no other benefit to sending them for an MRI or X-Ray within that first six weeks. The team of researchers then cited an essay teaching doctors to decline requests from patients without causing confrontation and in such a way that the patient does not feel their concerns are being dismissed.

MRIs To Be Restricted

Both the American Academy of Family Physicians and the American College of Physicians support the view set out by the National Physicians Alliance that imaging in low back pain should be restricted until after six weeks unless red flag conditions are present, such as severe spinal stenosis and spinal cord compression.


Ivanova, J., Bimbaum, H.G., et al, 2011, Real-world practice patterns, health-care utilization, and costs in patients with low back pain: the long road to guideline-concordant care, The Spine Journal, Vol.11, No.7, pp.622-632.

Srinivas, S.V., Deyo, R.A., et al, Application of “Less Is More” to Low Back Pain, Arch Intern Med. 2012; 1-5.

Chou, R., Fu, R., Imaging strategies for low-back pain: systematic review and meta-analysis, The Lancet, Volume 373, Issue 9662, Pages 463 – 472, 7 February 2009.

1 reply
  1. spine imaging
    spine imaging says:

    Thanks for sharing the information about MRI for low back pain. It would be good if you mention more about the possible risks and post scanning preparations.


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