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01-04-2013 | Radiology | Article

Over half of lumbar spine MRIs inappropriate, of uncertain value

Abstract

Free abstract

medwireNews: Magnetic resonance imaging (MRI) is vastly overused in patients with lower back pain, a Canadian study suggests.

In an analysis of 1000 requests for lumbar spine MRI, more than half were considered inappropriate or of uncertain value.

This high rate is not surprising, according to the researchers. "Lumbar spine MRI numbers have increased dramatically in recent years, but the correlation between lumbar spine MRI findings and clinical signs and symptoms is poor," comment lead author Derek Emery (University of Alberta, Edmonton) and colleagues in JAMA Internal Medicine.

Overuse of MRI poses a considerable problem to the healthcare system, they add, noting that it leads to excess costs and adverse outcomes.

The study was designed to prospectively determine the appropriateness of requests for MRI studies of the lumbar spine, and of the head for patients with headaches, at two large clinical centers in Edmonton, Alberta and Ottawa, Ontario.

Two expert panels comprising lumbar spine and headache specialists were established to determine the appropriateness of each request using appropriateness criteria from the RAND corporation/University of California, Los Angeles.

Of the 1000 requisitions for lumbar spine MRIs, just 443 were classified as appropriate. The remainder included 285 inappropriate requests and 272 requests of uncertain value.

Family physicians fared worse than specialists - just 34% of lumbar spine MRIs ordered by general practitioners were considered appropriate compared with 58% of those requested by specialists.

Among the specialists, neurosurgeons requested appropriate MRI scans for lower back pain more than 76% of the time, whereas neurologists and orthopedic surgeons ordered MRIs appropriately less than half the time.

By contrast, for headache, 83% of MRI requests were considered appropriate. Just 9% of the MRIs ordered for headache were considered inappropriate, and 8% of the requested scans were of uncertain value.

In their report, Emery and colleagues point out that MRI requests for the lumbar spine can comprise up to one third of all MRI requests in some regions. In eliminating inappropriate scans and some of uncertain value, harm resulting from unneeded investigations could be reduced, as could costs, they say.

The researchers add that overuse is often driven by patient expectations, physician concerns about litigation, and lack of accountability for cost.

"Solutions will require strict adherence to appropriate guidelines and better education of patients," they conclude.

By medwireNews Reporters

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