Low back pain and false positive MRI

Almost all of us develop low back pain at some point during our lifetime. It is the second highest cause of work absenteeism and great economical loss as well sufferings. More than 95% cases, this back pain is non-specific and does not need aggressive treatment. However, many patients get worried about back pain and want to exclude any serious cause. MRI is a common test for exclusion of serious diseases as a cause of back pain. But some studies questioned about the sensitivity and specificity of the test.
Asymptomatic patients with no back pain have been found to have a high incidence of positive MRI findings. Jensen and Coworkers have found that 64% of asymptomatic individuals who underwent an MRI had abnormal appearing lumbar discs at some level. These abnormalities seen on MRI often are not the origin for the patient’s back pain. It may be due to age-related spinal disc changes or other reasons. Over-reliance on the MRI as a sensitive tool for diagnosis the cause of back pain may lead to an incorrect diagnosis if not interpreted by skilled people.
Apart from the high incidence of false-positive results, MRI is an expensive test. Thus, we should always correlate with the symptoms and physical signs of the patient before making any diagnosis or intervention.
Though it has pitfall, MRI is useful in many serious causes of back pain and spine disorders. We have to make sure that it has been used and interpreted accurately along with patient’s signs and symptoms. It is important to give a second look to make final comment and treatment.

The write up is compiled by Dolilur Rahman, Senior Consultant of Physiotherapy, Bangladesh Physiotherapy Hospital, Dhaka.
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