[Diagnostic imaging in neck and low back pain]

Abstract

Background: Diagnostic imaging in neck and low back pain can confirm serious pathology, but the clinical significance of findings is often unknown. Indications for diagnostic imaging in these patients are presented and the significance of common findings is discussed.

Material and methods: The review is based mainly on Norwegian guidelines (evidence-based) on low back pain, other selected publications, and a non-systematic PubMed-search for systematic reviews and randomised controlled trials of imaging in neck or low back pain.

Results: Routine imaging in neck or back pain is not documented to improve patient outcomes and we therefore advise against it. Imaging is indicated when serious conditions are suspected and should be considered for symptoms that have not improved after 4-6 weeks. Of the imaging modalities available, MRI has the highest sensitivity for most important disorders in the neck and back. Degenerative changes in vertebrae and intervertebral discs (including disc herniations) are common also in asymptomatic individuals and usually have uncertain relation to pain. Some MRI findings in bone marrow (so called Modic-changes) are more frequent among patients with low back pain, but their relevance to treatment is not clarified.

Interpretation: Imaging (usually MRI) in neck or back pain is only recommended for suspected serious conditions or clear symptoms that have not improved after 4-6 weeks. Degenerative changes seldom explain symptoms or influence treatment.