Current medical technology allows for the amazing ability to obtain detailed anatomical analysis of the human body. The problem with this imaging is that when looking for the source of a problem there are several possible findings with imaging: abnormal findings causing the pathology, abnormal findings related to the problem that don’t affect treatment outcomes or decision making, and abnormal findings not associated with the condition. No place in the human body is more difficult in dealing with this dilemma that in the treatment of pathologies of the spine.
Imaging has become important in the decision making process of surgical versus conservative care. This process is made more difficult when previous research demonstrates high prevalence of abnormalities in individuals with and without symptoms of back pain.
Modic et al. performed a prospective study examining the role of imaging in prognostics of and outcomes of patients with low back pain or radiculopathy. 246 patients and their physicicans were divided into groups: the first received MRI results within 48 hours while the second group was blinded to MRI results (unless medically necessary to be told). All patients then underwent six weeks of conservative care including physical therapy and drug therapy.
Results of the study found no prognostic value of MRI over that of the clinical assessment. Size, type, and location of disc herniations were not associated with outcome. At the six-week follow-up, improvements were not significantly different between groups. One of the more interesting findings of this study was that knowledge of degenerative changes from MRI resulted in patients having a lesser sense of well-being despite similar outcomes. This supports the importance of medical professionals emphasizing that patients not obsess with results of imaging and instead focus improvements in functional status.
Modic, Obuchowski, Ross, Brant-Zawadzki, Grooff, Mazanec, Benzel (2005). Acute Low Back Pain and Radiculopathy: MR Imaging Findings and Their Prognostic Role and Effect on Outcome. Radiology, 237.