With the radical advancement of medical technology, we are presented with a wide array of imaging techniques which allow us a window into the inner workings and structure of the body like never before! These remarkable tools grant us access beneath the skin without making use of invasive surgeries and enable healthcare practitioners to make important diagnostic and therapeutic decisions.
While various imaging investigations such as X-rays, MRIs and CT scans have proved invaluable in identifying anatomical pathology in bones and the surrounding soft tissue, most patients with back pain can be managed successfully without imaging.
The misconception of most people seeking health care advice is that imaging, in whatever form, provides a definite, hard and fast diagnosis, which will lead to appropriate treatment and ultimate recovery. Unfortunately, this is not always the case, and in many instances, imaging investigations can actually be misleading.
Studies have repeatedly shown a poor correlation between the presence of structural pathology and the presence of low back pain. For example, if 100 healthy individuals without back pain undergo an MRI scan, up to 50 of them will show evidence of a “spine problem” including disc herniation and degenerative arthritic changes!
Sensitive tests such as MRI may thus fool you into thinking you have found the source of your pain when really the results are insignificant. On the other hand, the result of the MRI may indeed identify the cause of the pain, and this may not impact the course of treatment at all. In such cases, it is useful to ask yourself “How will the imaging results change things for me?” For example, the conservative treatment for a suspected disc herniation is no different from the conservative treatment for a confirmed disc herniation.
This is not to discredit the importance of imaging techniques, but rather to highlight the caution with which they should be utilised. Although there are many structural abnormalities that correlate poorly with pain, there are exceptions to this rule, and astute clinicians will know when imaging is appropriate to confirm a suspicion of such abnormalities.
In rare cases when something more sinister such as infection or tumour may be causing your pain, warning signs can be picked up by your health care provider through a detailed clinical history and physical exam. In these cases, the use of imaging may prove invaluable.
At the end of the day, qualified spine specialists are trained to know when it is appropriate to order imaging studies. It is important to find a physician you trust and work together toward resolving your back pain and regaining healthy functional movement.
Move Well. Live Well.