A recent study featured in the Journal of Neurosurgery showed a worrying figure: 52% of patients referred to a neurosurgeon would be willing to undergo back surgery if an MRI scan revealed abnormalities, even if they had no symptoms.
Hopefully, you find this as alarming as I do, but such a high percentage of people with this attitude tells me that I should take the time to explain the role of MRI scans in diagnoses and why they can sometimes make your outcome worse than if you didn’t get one.
The list of abnormalities that MRI scans can reveal sounds very scary: degeneration, disc bulges and disc protrusion, to name a few. If a physician was to tell you that you had a disc bulge, you might find that news very worrying, but would you still be worried if you knew that around 40% of 30 year olds without any back pain were found to have a disc bulge as well?
Still, you may think that just because you have no pain now doesn’t mean it won’t develop later but, again, there’s very little evidence that abnormalities found in MRI scans will get worse as time goes by.
The fact is, both back pain and painless spinal abnormalities are so common that links between the two are often coincidental, while the links between lifestyle, exercise and back pain are well proven. If we’re presented with a patient experiencing back pain, their desk bound job is far more likely to be the cause than anything an MRI will reveal.
Here’s an analogy I like to use: as we get older we get some wrinkles on the outside and we get some wrinkles on the inside. Sometimes, those “wrinkles” are all the MRI scan is showing. In fact, it would be more abnormal to encounter a back that didn’t reveal any abnormalities when scanned. The table below shows just how common abnormalities are in people experiencing no symptoms.
Despite this, people often insist on MRI scans and – as the study discusses – are often dissatisfied with their service if they don’t receive one. Less value is placed on the diagnosis of a physician versus that of a machine, despite the former having years of training and the latter being a tool.
Not only do MRI scans not necessarily reveal abnormalities worth treating, people who get MRI scans often have a worse outcome than those who don’t. It’s believed this is due to people avoiding movement and exercise as they’re worried about what the scan has revealed, resulting in worse recovery than people who skip the MRI and go straight to physiotherapy.
Sadly, the same study that revealed the attitudes towards MRI and surgery also showed that only 61% of patients believed that physiotherapy was as effective as surgery for treating back pain. If patient attitudes were based on current medical knowledge rather than perception, that figure would be north of 90%.
None of this is to say that MRI scans are useless, only that they should be used as a means of supporting the diagnosis of a physician, rather than a means of diagnosis itself.
For example, if we suspect symptoms are being caused by a pinched nerve, tumours, cysts or other sinister pathology, then we would always send for an MRI scan so that we can rule them out or recommend further treatment if it’s something we can’t treat with physiotherapy.
If it’s just back pain, then there’s rarely any need for an MRI scan and almost definitely no need for surgery. A simple exercise programme prescribed by a physiotherapist is non-invasive, cost-effective and more likely to improve or remove your symptoms.
Machines may not lie, but they don’t always have something worth saying.
David Wynne BSc (Physio) MSc (Sports and Exercise Medicine) MCSP MHCP
Musculoskeletal and Sports Physiotherapist, Research Lead at West London Physiotherapy
For any other questions regarding this topic please do not hesitate to contact West London Physio on 0207 937 1628 or email David at david@westlondonphysio.co.uk
