MRI and Epidural Steroid Injections for Low Back Pain and Sciatica
Tuesday, December 27, 2011 at 1:03PM | tagged "back pain" sciatica, "epidural steroid injection" "MRI", "low back pain", "lower back pain" "low back pain" "pain physician" "idaho falls physician", low back pain, radiculopathy Share Article | Email Article Low back pain one of the three top reasons people seek medical care and a leading cause of disability worldwide.
Despite all the people walking around with back pain, consensus about how best to treat back pain is an evolving issue.
A recent study published in the Archives of Internal Medicine highlights issues with decision making about how best to treat low back pain.[i] The study results are most informative in the context of a clinical scenario that presents itself to me every day.
A patient walks into the office describing low back and leg pain. He (or she) has a history and examination suggestive of sciatica (or radiculopathy). The patient has tried physical therapy or other conservative interventions without success. What do we do now? Often these people will (1) get an MRI and (2) have (or at least consider having) an epidural steroid injection.
A study from a group at Johns Hopkins School of Medicine raised a question about whether getting an MRI before an epidural steroid injection improved outcomes. [ii] The researchers conducted a randomized controlled trial. For the patients in group 1 the treating physician was blinded as to MRI results. In group 2 the physician decided on the treatment after reviewing the MRI. A total of 132 patients were randomized into these two groups. The results researchers found that outcomes at one and two months were very similar for both groups.
The authors concluded that “the results suggest that although MRI may have a minor effect on decision making, it is unlikely to avert a procedure, diminish complications, or improve outcomes. Considering how frequently ESIs are performed, not routinely ordering an MRI before a lumbosacral ESI may save significant time and resources.” [iii]
The results are interesting, at least to a treating physician that routinely performs epidural injections. Often I feel like I know what we are going to do but order an MRI to cover myself from a medicolegal perspective. That is not to say that MRIs are not a useful tool. I order a lot of MRI studies and they are very appropriate in a wide range of medical situations. As we consider, though, reform of our medical system and better using our resources this study provides insight into a common clinical situation and maybe give direction about how we can better use resources.
[i] Arch Intern Med. Published online December 12, 2011
[ii] Arch Intern Med. Published online December 12, 2011
[iii] Arch Intern Med. Published online December 12, 2011
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