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Study: Skip The MRI Before A Sciatica Injection

December 16, 2011
Written by: , Filed in: Musculoskeletal Radiology
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Routine MRI scans provide no benefit when given prior to epidural steroid injections, the most common procedure performed at U.S. pain clinics, according to a new study led by Johns Hopkins researchers.

The study, published online this week in Archives of Internal Medicine (and freely available), examined treatment for sciatica at several U.S. pain clinics. Most common is an epidural steroid injection (ESI) of cortisone directly into the outermost part of the spinal canal in the lower back.

Steven P. Cohen, MD, an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine in Baltimore, led the research. He and his team treated 132 patients, split into two groups.

Both groups received MRI, but the treating doctor did not review the scans for one group. Instead, patients in that group received epidural steroid injections guided solely by the doctor’s physical exam and the patient’s description of the location and intensity of the pain. A physician not involved in the exam or treatment did later review the MRI.

In the second group, doctors did look at the MRI results and used them to help determine where, or whether, to place the needle for injection.

After three months, researchers reported no difference in reported pain or ability to function between patients in each group.

“Our results suggest that MRI is unlikely to avert a procedure, diminish complications, or improve outcomes,” said Dr. Cohen, as quoted in a Johns Hopkins news release. He added:

If we’re trying to cut back on unnecessary medical costs, we should stop routinely doing MRIs on almost everyone who comes to us needing ESIs.”

Part of the problem in using imaging is that back pain is so tricky. “If you look at 100 middle-aged people who have never had back pain, two thirds of them would have abnormalities on MRI,” Dr. Cohen said. “This makes it difficult to use imaging to guide injections.”

On the other hand, MRI scans come back as normal for some people who complain of back and leg pain, because the pain may originate elsewhere.

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

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