Study finds X-rays very helpful for diagnosing low back problems

(Boston)— Plain radiographs (X-ray), computed tomography (CT) scans and magnetic resonance imaging (MRI) are commonly used in the evaluation of lower back pain. While MRI use has increased most over the past decades (more than 300% from 1994-2005), its use in low back pain (LBP) management can be associated with added costs and increased surgical interventions.

A new study from researchers at Boston University Chobanian & Avedisian School of Medicine has found that in cases of low back pain without worrisome signs, use of an X-ray is often sufficient to diagnose the problem.

“Imaging, used in the management of low back is not always needed, but when employed there can be an overuse of MRI which adds to patient wait times, costs and the potential for more false positives,” says corresponding author Michael D. Perloff, MD, assistant professor of neurology.

Researchers selected 100 patients from an outpatient pain clinic who had undergone lumbar X-rays within one year prior to undertaking a lumbar MRI. X-ray and MRI reports were analyzed by two readers. They found X-rays predicted MRI results in approximately 75% of the cases for common low back pain problems suggesting they may be a preferred initial imaging study for this condition.

According to the researchers, MRI use does not necessarily change low back pain outcomes and may increase surgical rates. “Patients should be reassured that X-rays can be very helpful for management of low back problems and an MRI is only needed in certain cases. Furthermore, with less need for low back MRIs, the procedure would be more available for other disorders, reducing wait times and systems burden,” said Perloff, a neurologist and director of Pain Medicine at Boston Medical Center.

These findings appear online in the American Journal of Physical Medicine & Rehabilitation.