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Rapid MRI costs more but offers little benefit over x-ray for diagnosing the cause of low back pain

Use of rapid magnetic resonance imaging (MRI) instead of x-rays for initial diagnostic imaging of patients who have low back pain has become more common. However, replacing lumbar spine x-rays with rapid MRI in primary care patients with low back pain results in no long-term differences in disability, pain, or general status, and rapid MRI costs more, according to a recent study supported in part by the Agency for Healthcare Research and Quality (HS09499).

Jeffrey G. Jarvik, M.D., M.P.H., of the University of Washington, and his colleagues randomly assigned 380 patients whose primary care doctors had ordered that their low back pain be evaluated by radiography to receive lumbar spine evaluation by rapid MRI or x-ray. The researchers examined back-related disability, health status, pain, preference, satisfaction, and costs.

A year later, the 170 x-ray patients had a mean back-related disability Roland score of 8.75 vs. 9.34 for the 167 rapid MRI patients, a clinically insignificant difference. Mean differences between patients in the two groups in how much the pain bothered them, pain frequency, bodily pain, and physical functioning were not significant. Ten patients in the rapid MRI group versus four in the x-ray group had lumbar spine operations.

The rapid MRI strategy had a mean cost of $2,380 versus $2,059 for the x-ray strategy, but MRI costs were higher overall due to the additional spine operations it prompted. Although patients and physicians preferred the rapid MRI for the reassurance it offered, it provided little benefit over x-ray.

See "Rapid magnetic resonance imaging vs. radiographs for patients with low back pain," by Dr. Jarvik, William Hollingworth, Ph.D., Brook Martin, B.S., and others, in the June 4, 2003, Journal of the American Medical Association 289(21), pp. 2810-2818.

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