How many times have you heard the phrase “My back is killing me?” Almost every American has had an episode of back pain or knows someone who has had significant back pain. Acute low back pain (LBP) is one of the most common health maladies in the United States and is the leading cause of disability in people younger than 45 years old. It is responsible billions of dollars in health care costs, and is a leading cause of missed work.
One of the most common questions that people ask is “Do I need to get an MRI if I have back pain?” However, at a time when healthcare spending is under tremendous scrutiny, it is not uncommon for expensive special tests such as MRI’s to be denied by insurance companies. In view of this, I have asked Jamie S. Stallman, MD, a local radiologist at Advanced Imaging Specialists, to address the indications for MRI testing for LBP.
LBP is divided into two very different categories. The first is uncomplicated LBP, and the second is complicated LBP. When pain is localized to the lower back (lumbar) region and there are no complicating factors, this is considered “uncomplicated” and no medical imaging is required. Uncomplicated LBP is usually a self-limiting condition, meaning that it goes away by itself without any treatment. Most people with this condition will experience relief of symptoms within a month and can resume normal activities without difficulty. Treatment for uncomplicated LBP is usually limited to over-the-counter medication, rest, and physical therapy. Imaging is not usually performed because the cause of the pain is related to muscles or connective tissue around the spine in the majority of cases.
In contrast, complicated LBP requires additional investigation by your health care provider. There are a few key features of complicated LBP that are important to remember. When any of these factors are present, it is possible that there may be a specific cause of the pain, such as a disc herniation, fracture, soft tissue lesion, spinal stenosis, or infection. The following is a list of “Red Flags” that puts back pain into the “complicated” category:
If any of these conditions apply to a patient with back pain, then a medical professional must be consulted. In most of these cases, the health care provider will order some type of imaging to try to identify the cause of the pain. An MRI is the most common test ordered to evaluate back pain but there are three other imaging modalities also used.
MRI: Magnetic Resonance Imaging is the best, and most commonly used imaging modality for spine problems. The MRI scanner utilizes strong magnets and radio waves to create images of the spine and surrounding anatomy. MRI provides the best pictures of disc hernations, ligaments, connective tissues, and nerves in the spine due to its superior pictures of soft tissues.
X-ray: These are pictures produced by passing x-ray beams through the area of interest. X-rays mostly depict abnormalities that occur with bony structures such as fractures, listheses (or “slippage”), and disc spaces.
Bone Scan: This test produces images from a radioactive chemical that is injected into a patient’s vein. Bone scans are very sensitive for detected bone abnormalities including fractures. Bone scans also have the ability to image the entire skeleton all at once.
CT Scan: CT, or Computed Tomography is commonly referred to as a “CAT” scan. Images are produced when a patient is placed lying down into the scanner (shaped like doughnut) where an x-ray tube rotates around in a circle. A computer then reconstructs highly detailed images of the bones and soft tissues of the spine.
A patient with complicated low back pain will be examined by a health care professional who will usually recommend that one or more of the above imaging modalities be considered. These tests are performed at most hospitals and outpatient imaging centers. The actual pictures are taken by a trained technologist. The radiologist, who is a physician specially trained in medical imaging, will then interpret the images and consult with the referring health care provider. Based on the imaging findings and clinical history, a treatment plan will then be initiated.
So the next time you have back pain, remember that you may not need anything more than over-the-counter medicine, but if any of the “Red Flags” are present you should contact your health care provider.
GUEST COLUMNIST: Dr. Jamie Stallman is radiologist at Advanced Imaging Specialists in Dunmore, PA.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum" in the Scranton Times-Tribune.
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.
