My back went out. Should I get an MRI?

  • Posted on: Jan 24 2019
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Back and neck pain are common conditions. 12-14% of US adult population above the age of 18 years would visit a doctor with these complains in any given year. These numbers do not include visits to chiropractor or physical therapists. It is well-known that a majority of new episodes of back or neck pain improve over time, with most improving within the first 4-6 weeks. With these figures in mind, it is sensible that most experts recommend against getting MRI in the early stages of the event.

MRI, or Magnetic Resonance Imaging, is a radiological examination of an involved body part, where images are created using radio waves generated by placing a person in a strong magnetic field. It provides detailed anatomic sectional images of human body and can shows bone, internal organs, soft tissues (muscles/ligaments/tendons), blood vessels and even areas of inflammation. This test does not involve any ionizing or harmful radiation. The recommendations of avoiding MRI early in are a cost saving measure of an exponentially rising cost of healthcare. Moreover, the treatment steps of “minor” neck or back pain is quite standard, irrespective of the MRI findings. 

There are occasions when MRI might be reasonable in early stages though. These salient factors that tilt the balance in favor of the early scan are called “red flags”. Essentially, they point towards a more serious problem, like a spinal fracture, tumor, infection, or a large herniated disc (which if not treated in a timely manner could cause a permanent neurological problems). The list of “red flags” vary from one group of experts to another, but most agree on following:

  • Major trauma (minor in elderly)
  • Associated fever/chills/night sweats or recent weight loss (10-15 pounds in 2 weeks or less)
  • Personal history of a cancer
  • Pain that does not resolve after lying flat or pain in the night-time
  • Loss of urine or bowel control, or numbness in buttocks
  • Rapidly progressing neurological deficit (clumsy hands, foot drop, balance issues, generalize arm or leg weakness/numbness)
  • Lancinating or shock-like pain down the spine by looking down

Other minor red flags include:

  • Age < 18 years or more than 50 years
  • Duration of pain more than 4 weeks
  • History of intravenous drug use
  • Immunocompromised state
  • Recent abdominal or pelvic procedure
  • Pain that radiates below elbow or knee

If you happen to have a new episode of neck or back pain, but do not have any of these “red flags”, there is no immediate need for a scan. Early treatment for minor episodes is home based exercise routine, physical therapy or chiropractic adjustments with or without mild over the counter analgesics. If you do happen to have any of these “concerning signs”, contact your doctor’s or our office for an urgent appointment.

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