Evidence Based Rehab

Lancet recently published a systemic review looking at routine imaging for Low Back Pain (LBP) without "red flags" that would suggest serious underlying conditions (eg, myelopathy, cancer, fracture, etc). While the results aren't surprising to the majority of conservative musculoskeletal practitioners, they do need to be publicized to the general public just as much as the silly studies that show "acupuncture" being effective treatment fot LBP. The authors conclude:

Lumbar imaging for low back pain without indications of serious underlying conditions does not improve clinical outcomes," they conclude. "Therefore, clinicians should refrain from routine, immediate lumbar imaging in patients with acute or subacute low back pain and without features suggesting a serious underlying condition

However, despite studies that show MRI's done for LBP and work related injuries tend to lead to poorer outcomes, and that much of what is foung (DDD, spondylosis, Disc herniations) are "normal" findings, the authors seem pessimistic in MD's changing their behavior.

...there is no compelling reason why more attention should be paid to low back pain than to any other prevalent condition." Other factors include patient expectations about diagnostic testing, reimbursement structures that provide incentives for imaging, and the fear of missing relevant pathology...

Throw in great marketing for spinal surgery, these imaging results are a great stepping stone to push invasive surgery for non-specific low back pain. So, get the word out - stop the excessive imaging and treat LBP initially with what we know has the greatest return for the least potential harm - Physical Therapy, education, and gentle return to activity.

Labels: evidence based medicine, guidelines, Low back pain, MRI