In a word, no. While It’s true that medical imaging modalities like x-ray, CT scan and MRI are incredibly useful diagnostic tools, they only have limited effectiveness when it comes to LBP (i.e. nonspecific LBP). Even MRI, the gold standard for so many medical conditions, is rarely useful for this condition.1–4 Why is this? Rather counter-intuitively, it’s not due to a lack of resolution, but rather the number of false positives that occur. Basically, this means people without LBP often show abnormal findings (e.g. disc degeneration or bulging – i.e. the very things you would expect to cause pain!). For example, one review (33 studies) found that 20% of 20 year olds, 60% of 50 year olds, and 84% of 80 year olds had disc bulges.5 That’s far more people than are actually experiencing LBP! Another study found that half of those subjects who had not experienced LBP had abnormal findings.2 That’s a lot! This poor correlation between abnormal findings and LBP can make it virtually impossible to tell whether medical imaging findings are responsible for a person’s LBP, or if they are simply coincidental.4 This makes imaging for nonspecific LBP a waste of time and money for not only the person with LBP, but also the healthcare system. Medical imaging can also expose people with LBP to unnecessary radiation (x-rays and CT scans), and worst of all, it can mess with their heads! More often than not these imaging techniques leave a person with a scarily long list of abnormal findings. And rather than thinking of them as ‘internal grey hairs’, often people are left feeling like ‘broken’ individuals (which unfortunately is reaffirmed every time they experience any pain/discomfort in this area). For these reasons, major LBP guidelines do NOT recommend medical imaging for nonspecific LBP6–9. Here, here!
• Medical imaging (e.g. x-ray, CT scan and MRI) is NOT usually effective for diagnosing LBP, due to a large amount of people without LBP having abnormal findings (false positives).
• Major LBP guidelines do NOT recommend imaging for LBP.
1. Webster BS, Cifuentes M. Relationship of Early Magnetic Resonance Imaging for Work-Related Acute Low Back Pain With Disability and Medical Utilization Outcomes. J Occup Environ Med. 2010;52(9):900-907. doi:10.1097/JOM.0b013e3181ef7e53.
2. Savage RA, Whitehouse GH, Roberts N. The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males. Eur Spine J. 1997;6(2):106-114. http://www.ncbi.nlm.nih.gov/pubmed/9209878. Accessed April 13, 2018.
3. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. doi:10.3174/ajnr.A4173.
4. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain. N Engl J Med. 1994;331(2):69-73. doi:10.1056/NEJM199407143310201.
5. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. doi:10.3174/ajnr.A4173.
6. van Tulder M, Becker A, Bekkering T, et al. European guidelines for the management of acute nonspecific low back pain in primary care (Chapter 3). Eur Spine J. 2006;15(S2):s169-s191. doi:10.1007/s00586-006-1071-2.
7. O’Connell NE, Cook CE, Wand BM, Ward SP. Clinical guidelines for low back pain: A critical review of consensus and inconsistencies across three major guidelines. Best Pract Res Clin Rheumatol. 2016;30(6):968-980. doi:10.1016/j.berh.2017.05.001.
8. Delitto A, George SZ, Professor A, et al. Low Back Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association Associate Professor in Physical Therapy and Orthopaedic Surgery, Program in Physical Therapy HHS Public Access. Man Ther. doi:10.2519/jospt.2012.42.4.A1.
9. O’Connell NE, Cook CE, Wand BM, Ward SP. Clinical guidelines for low back pain: A critical review of consensus and inconsistencies across three major guidelines. Best Pract Res Clin Rheumatol. 2016;30(6):968-980. doi:10.1016/j.berh.2017.05.001.