It is estimated that Americans undergo approximately 40 million MRIs every year, resulting in the United States being among the most image populations on the planet. There is real concern among many healthcare policymakers as to whether or not all of this diagnostic imaging results in improved health outcomes for patients here in the US. Of all those scans performed every year here in the US, over 10 million of them are performed on the spine alone. Despite how commonly this study is ordered by primary care providers, orthopedic surgeons, and spine specialists, most patients are largely unfamiliar with what to do with the information that results from their MRI reports and images. Indeed, many patients get conflicting information depending on which healthcare specialist they choose to see regarding their spinal MRI.
It’s all there in black and white… Or is it?
So you received your referral, you laid down on the table, then listened to the loud noises in the scanner, and finally finished your spine MRI. Now, all there is left to do await the radiologist’s report, which should clear things right up by explaining why your spine hurts, right? Not so fast! It’s probably going to cause some anxiety in many of you to learn that the latest research into how much time a radiologist spends per image is 3-4 seconds¹. Yes, you read that correctly, a mere 3 or 4 SECONDS per image! Given that bit of information, it shouldn’t surprise you to hear that the reports that come from MRI scans of the spine vary significantly when different radiologists look at the same images. In other words, there is A LOT of room for interpretation when it comes to creating a report for a spine MRI scan, and much of the report is not standardized from doctor to doctor. That might be why research found that:
“the majority of orthopaedic surgeons are not routinely reading radiology reports.”²
In addition, there is quite a lot of information about the overuse of imaging for spine-related pain symptoms and lower back pain in particular. However, if you have been lucky enough to have a spinal MRI performed, you are often faced with a dilemma. What do you and your doctor do about an abnormal spine MRI? Which spine surgeon is the “best”? Will this condition limit my ability to move normally or continue working? It a scary situation to face such a diagnosis that confirms your suspicions.
The good news about abnormal MRIs, depending on your perspective
The good news is that if 100 patients over the age of 60 that have never had back pain had a spine MRI scan, as many as 60 of the 100 would be expected to have significant abnormalities on the MRI. Stating this differently, at the age of 60, a typical patient without back pain would be expected to have an abnormal MRI scan based on chance alone. All the more confusing, some studies report that almost 1 in 4 patients with back pain have a normal MRI scan. I think we are starting to get the picture here. A Spine MRI is not the most critical determinant of what may be causing your back pain based on decades of medical research. It is extremely important to consider the result of your MRI with all of this in mind, and the MRI should almost never be the only justification for an invasive treatment such as spine surgery.
The next step on your journey to evaluation and ultimately treatment
First, a bit of advice. NEVER say to a medical professional involved in your spine care the following: “I don’t care, I just want to get fixed!” Thankfully, the human body is not anything like a car or other machine that you can simply bolt a part on and carry on your merry way! I could fill my lobby with patients that have made the mistake of going down that road. Consider that the word “fixed” sounds a lot like “fused,” and when you “fix” something, you often use screws and hardware, and what a coincidence, a spine surgeon, often makes use of screws, rods, and assorted hardware for spinal “fusion” surgery. Do you see how your primary care doctor could get the wrong idea about what you are asking for here? At the end of the day, your primarycare provider is quite sure what to do with a case of a patient with stubborn or severe acute back pain, and that’s how many patients end up in a surgeon’s clinic. To be clear, I am biased against surgery unless there are clear indications to perform one. Indeed there are occasions where the benefits outweigh the risks, but the patient should be well aware of the very real potential downsides. The question I ask is, why would you want to see a surgeon first, and why do primary care providers send you there first when statistically speaking, you are very unlikely to require surgery.
As you contemplate your next step, consider the source of the information you receive:
Primary care provider: Ordered the spine MRI due to a concern about your back pain. Whether spinal MRI was indicated or not is an ongoing debate across the vast reaches of healthcare. It’s too late now though, all those “abnormalities,” disc bulges, and arthritis must be dealt with once and for all! Off to the surgeon you go to get fixed! After all, that is what you asked for?!
Radiologist: Considering the average 3-4 seconds per picture, the fact that they haven’t and likely never will meet you, and the fact that medical research has found the spinal MRI unreliable in linking MRI changes with actual sources of pain, it’s safe to say we better get more input. The surgeon should be happy, though; it turns out the radiologist has found plenty of things that need fixing!
Spine Surgeon: A lobby full of patients, surely somebody out there needs surgery? After all, we “fix” people here!
I don’t want to come off as too flippant or not serious about the situation. The reality is that literally, millions of people across the country are struggling to manage through the very real physical pain they are suffering in their spine. They are often desperate for answers and help. My concern is with traditional medicines approach to spinal pain in the face of decades of research and thousands of personal encounters with patients at varying stages of their battle with pain.
My Advice? A Spine Pain Specialists perspective:
After speaking with your primary care provider, don’t rush in for the so-called “fix” that leads to major invasive spine surgery, perhaps unnecessarily. Seek out a specialist in spine pain from a non-surgical specialty for a healthy dose of cautious skepticism and surgical alternatives. If you don’t get the relief you are looking for, you can always reconsider your surgical options. I meet far too many patients who rushed in only to regret their impatience and lack of appreciation for what they were signing up for what they thought was going to “fix” their spine condition.
At Elite Pain & Health, we pride ourselves on delivering comprehensive patient-centered spine and joint care for our patients. We have dedicated our careers to focus on the delivery of the most advanced surgery-free and minimally invasive treatments available. We look forward to the opportunity to help you or your loved ones with the compassion they deserve. Contact us today for your complete evaluation, diagnosis, and treatment. You may call us directly to book your appointment or choose your preferred appointment time through our online scheduling tool.
1) McDonald RJ, Schwartz KM, Eckel LJ, Diehn FE, Hunt CH, Bartholmai BJ, Erickson BJ, Kallmes DF. The effects of changes in utilization and technological advancements of cross-sectional imaging on radiologist workload. Acad Radiol. 2015 Sep;22(9):1191-8. doi: 10.1016/j.acra.2015.05.007. Epub 2015 Jul 22. PMID: 26210525.
2) Kruger P, Lynskey S, Sutherland A. Are orthopaedic surgeons reading radiology reports? A Trans-Tasman Survey. J Med Imaging Radiat Oncol. 2019 Jun;63(3):324-328. doi: 10.1111/1754-9485.12871. Epub 2019 Mar 12. PMID: 30861612.