Background In industrialized countries, low back pain (LBP) is one of the main causes of health-related and social costs [1,2]. Lumbar Spine Magnetic Resonance Imaging (LSMRI) is not recommended when there are no signs suggesting that the pain is caused by systemic diseases or radicular compression; in these cases, any potential findings on LSMRI have shown to be irrelevant [1-3], and do not help to refine the diagnosis or improve the outcome.
Objectives To asses the appropriateness of prescription of LSMRI in patients with LBP or sciatica in a Rheumatology Unit specialized in management of Work Disability processes because of Musculoskeletal pain (M-WD)
Methods Retrospective review of patients referred to M-WD Unit from march 2013 to january 2015. Patients in which a LSMRI was performed along the follow-up in the Unit were included, being the LSMRI prescribed by the rheumatologist, a mutual or private insurance Clinic or by other specialties physicians. Patients with previous lumbar spine surgery were excluded. Assessment of appropriateness of LSMRI was performed based on the indication criteria established by the American College of Physicians and Radiology, and current evidence-based clinical guidelines (Table 1). Epidemiological data, LSMRI prescriptor and diagnosis of the study were collected.
Results Along 22 months, 134 patients were followed up in the M-WD Unit because of LBP (78; 58,2%) or sciatica (56; 41,8%). LSRMI was performed in 44 patients (32,8%), 22 males (50%), with a mean age of 45,5 years, 6 patients (13,6%) with LBP and 38 (67,8%) with sciatica. LSMRI diagnosis were: 7 spondylosis and/or disk degeneration (15,9%), 2 spinal stenosis (4,5%), 1 spondylolisthesis (2,3%), 15 studies with 1 or more disk herniation (34%), 10 with 1 or more prolapsed disks (22,7%) and 4 studies were normal (9%). 5 studies were missed. LSMRI were prescribed by: mutual or private insurance Clinic in 11 patients (25%), rheumatologist (20; 45,4%), other specialties (general physicians, rehabilitation physicians, thraumatologists or nerologists) (13; 29,5%). 5 out of 11 LSMRI (45,4%) prescribed by mutual or private insurance Clinics were appropriate, 12 out of 20 (60%) prescribed by the rheumatologist were appropriate and 3 out of 13 (23,1%) prescribed by other specialties physicians. In total there were 24 inappropriate LSMRI (54,5%), being 16 (66,7%) prescribed by mutual/private insurance Clinics or other specialties physicians.
Conclusions An important proportion of LSMRI without any appropriateness criteria is observed, mostly when prescribed by other specialties physicians.
Airaksinen O et al. European guidelines for the management of chronic nonspecific low back pain. European Spine Journal 2006;15 (Suppl. 2): S192–300 [chapter 4]
Davis PC, et al. ACR Appropriateness Criteria© on low back pain. Journal of the American College of Radiology 2009;6:401–7
Kovacs FM, et al. Vertebral endplate changes are not associated with chronic low back pain among southern European subjects: a case control study. American Journal of Neuroradiology 2012;33:1519–24
Disclosure of Interest None declared