Patients with back pain often insist on obtaining an MRI, even when we think it is not necessary. When this happens, we try to educate the patient as to the proper use of x-rays and MRIs. Frequently we are able to convince the patient that the study may be inappropriate.
Our explanation is the following: An x-ray is an excellent study to look at the bones in the back, but does not really look at the nerves or the discs. The MRI is an excellent study to look at the discs and the nerves in the back, but does not look at the bone the same way an x-ray does. We use an x-ray when we are concerned about conditions involving the bones such as a fracture. An”x-ray” can be either the standard form or the CT form. CT’s are more detailed and are not usually the first line in the diagnostic work up.
It should be noted that most patients with low back pain or neck pain get better on their own without any interventional treatments, but this may take a period of six weeks. Therefore, it is not wise to rush into taking an x-ray of the cervical or lumbar spine unless back pain has been present for more than six weeks or unless there has been severe unremitting pain worsening day-by-day or history of trauma or other illness.
As mentioned, MRI’s are useful for checking to see if there is any nerve impingement. This test is typically ordered if the patient has pain, numbness, tingling, or weakness into either an arm or leg. The MRI is an excellent test to check for diseases such as herniated disc, disc degeneration, tumors, spinal stenosis and spondylolisthesis. If a herniated cervical disc or a herniated lumbar disc is suspected and pain is persistent an MRI may be ordered.