The therapeutic impact of lumbar spine MRI on patients with low back and leg pain

Does early imaging influence management and improve outcome in patients with low back pain? A pragmatic randomised controlled trial

“…Changes were observed in both groups (highlighting the value of the randomised control design and showing that previous non-randomised studies assessing the impact of imaging on diagnosis and management are likely to have overestimated the contribution of imaging to clinical decision-making). 34,38,39,45 However, the only difference observed was greater clinician confidence in the diagnosis in the 'early imaging' group, with no apparent difference in diagnosis or management plan. In this context, there was some evidence 66 that imaging was more helpful to the non-back specialist, where there was considerably more doubt over the diagnosis.…”

“…Historically, most published studies on the clinical efficacy of imaging have focused on technical and diagnostic accuracy. While a few studies have attempted to assess diagnostic and therapeutic impact, 30,[34][35][36][37][38][39][40][41][42] there is little evidence that the use of sophisticated imaging significantly improves patient health or quality of life. 36,39,[42][43][44][45][46] More recently, the evaluative framework has been extended to include a sixth level (impact on society) to include cost-effectiveness 27,32,47 in recognition of the need to evaluate the impact of new technologies on the associated costs to both service users and service providers.…”

Diagnosis of the Vertebral Level from Which Low Back or Leg Pain Originates. A Comparison of Clinical Evaluation, MRI and Epiduroscopy

“…MRI is considered by many to be the gold standard for localization of common spinal pathology, but the accuracy of MRI has been questioned 5–11 . These limitations may make the choice of the correct level of therapeutic intervention challenging 1,12 …”

Influence of Imaging on Clinical Decision Making in the Treatment of Lower Back Pain

“…Most health technology assessments of imaging (5,8,9) focus on technical and diagnostic performance (8,10,11), with a minority (12)(13)(14)(15)(16)(17)(18)(19)(20) addressing the broader influence of imaging on clinical decision making, patient treatment, and outcome.…”

“…Investigators in some studies (19,20,29,30) who reported considerable changes in diagnoses, treatment plan, and diagnostic and therapeutic confidence after either CT or MR imaging acknowledged that patient symptoms could change in the interval between assessment and imaging. Another limitation of this type of evaluation is that clinicians may not actually follow their reported treatment plan.…”