Lumbar Spine MRIs 'Frequently Inappropriate'

Cheryl Clark, March 27, 2013

In Canada, more than half the requests for MRI scans of patients' lumbar spines were "substantially" inappropriate or of uncertain value, a finding the study's author says is probably even greater in the United States.

"The thing about Canada is that we have limited access to MRI, whereas in the United States, effectively, you don't have limits for people who can afford it; there's no waiting list and no limitations on access," says Derek J. Emery, MD, associate professor and neuroradiologist at the University of Alberta, and principal author of the paper published Monday as a Research Letter in JAMA Internal Medicine.

The overuse of such magnetic resonance imaging tests is a problem because of false positives and unnecessary excess costs. "For most patients, imaging (findings) won't contribute to their care and management," he says.

Lumbar spine MRI overuse is significant because, Emery says, such scans make up one-third of all MRI scans in some regions and add considerably to healthcare costs. In Canada, he said, the cost of these images is about $400.  A quick Internet search of lumbar MRI scans in the U.S. revealed a range of between $1,700 to $2,175 each, and that's without use of contrast agents.

Overutilization of lumbar spine MRI scans for various manifestations of pain including radiculopathy or claudication, were seen as inappropriate 28.5% of the time, and of uncertain value in 27.2% of 1,000 requests studied. Only in cases where the symptom was postoperative back or leg pain was the scan deemed appropriate, which was in 95.8% of 167 cases.

"Overuse of medical interventions, such as MRI, is a considerable problem, leading to excess costs and adverse outcomes," the researchers wrote.  This overutilization is driven by patient expectations, physician concerns about litigation, and lack of physician accountability for cost.

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