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MRI scans unnecessary for back pain patients treated with steroid injections

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For patients with sciatica, MRI scans could be an unnecessary step in the treatment process if surgeons follow guidelines that advise the imaging before epidural steroid injections, according to a recent study published in the Archives of Internal Medicine.

“Our results suggest that MRI is unlikely to avert a procedure, diminish complications or improve outcomes,” Stephen P. Cohen, MD, head author and associate professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine, stated in an university press release.

Cohen and his colleagues split 132 patients into two groups, one where a patient only received a physical exam from their physician before epidural steroid injections (ESI) and another where the physician conducted both a physical exam and consulted an MRI result before ESIs. An independent physician reviewed the MRI results and proposed treatment in the non-MRI group to compare the decision-making.

The investigators found that having the MRI had no significant effect on patient pain results. The independent physician agreed with the physician who did not see the MRI results 66% of the time. After 3 months, 35.4% of the non-MRI group reported a positive outcome compared with 40.7% in the MRI group. In both groups, no differences in pain scores or function were reported at 3-month follow-up.

Of 5 cases in the MRI group where the physician did not give the patient a steroid injection based on imaging results, 3 patients came back within 6 months to get the injection anyway. Patients in both groups would not have received ESIs in 6.8% of cases if the MRI were reviewed in their group, according to the abstract.

“Considering how frequently these epidural injections are performed, not routinely ordering an MRI before giving one may save significant time and resources,” Cohen said.

Reference:

• Cohen SP, Gupta A, Strassels SA, et al. Effects of MRI on treatment results or decision making in patients with lumbrosacral radiculopathy referred for epidural steroid injections. [Published online ahead of print Dec. 12, 2011] Arch Intern Med. 2011. doi:10.1001/archinternmed.2011.593
• Disclosure: Cohen has no relevant financial disclosures.

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