The Overuse of MRI in Spine

March 7, 2019

I have had the benefit of having practiced long enough to have practiced for 10 years before MRI’s ever existed.  MRI’s (Magnetic Resonance Imaging) came into being in 1988 or 1989 and now has become a double edged sword.  It’s a wonderful to support what the clinical diagnosis is.  The classical way of taking care of someone is to clinically decide if they have a herniated disc based on a nerve root compression, weakness of the wrist, weakness of the foot, or inability to walk.

This clinical diagnosis was always supported by other tests.  Since the MRI has come into being, doctors no longer truly examine anymore.  This is due to the poor training programs in medical school and residency (which is what I have seen).  The end result is that the doctors determine the diagnosis solely based on an MRI.  Two clinical studies, Abnormal Magnetic-Resonance Scans of the Lumbar Spine in Asymptomatic Subjects published in 1990 in the Journal of Bone and Joint Surgery as well Magnetic Resonance Imaging of the Lumbar Spine in people without Back Pain published in 1994 in the New England Journal of Medicine basically created a basis of where normal MRI’s can be described.

MRI’s in 30 to 40% of cases will have something so significant you can justify surgery even in normal individuals.  I recommend you review these two articles (just the summary would be sufficient).  Understand that over 1/3 of people have abnormal MRI’s the older you get.  If someone has back pain, BEWARE.  If a surgeon is rushing you to get back surgery, get a second opinion.  Many times the MRI will not correlate with the medical problem you have.