MRI for Assessment of Sciatica
In the March 14, 2013 issue the New England Journal of Medicine published an article on the use of MRI to evaluate persistent sciatica in cases of known lumbar disc herniation. The study found that 1 year after treatment, MRI imaging did not distinguish between favorable vs unfavorable outcomes. These findings leave unanswered questions for both patients and physicians.
A prior study by MC Jensen, also published in the New England Journal of Medicine, demonstrated that 30% of volunteers without symptoms had lumbar disc protrusions. Therefore, we know that disc abnormalities are not always painful.
Clinical experience has shown us that disc protrusion and extrusion at other levels of the lumbar spine are common. When we obtain MRI due to pain complaints from our patients we see problem at additional levels. Therefore, clinical judgement is important. A concern is that patients will be denied MRI due to the uncertainty expressed in this study.
This study shows us that the role for repeat MRI in persistance pain is not clear. Hopefully additional information will help clarify the usefulness of MRI in chronic low back and leg pain. We will continue to advocate for patient care during these uncertain times for both patients and physicians