Abstract
Back pain is common and costly. While a general scene of back pain related practice in China remains unknown, there are signs of excessive use of lumbar spine magnetic resonance (MR). We retrospectively studied 3107 lumbar spine MRIs in Eastern China to investigate the appropriateness of lumbar spine MR use. Simple back pain is the most common chief complaint for ordering a lumbar MR study. Only 41.3% of lumbar spine MR studies identified some findings that may have potential clinical significance. Normal lumbar spine is the most common diagnosis (32.7%), followed by lumbar disc bulging and lumbar disc herniation. Walk difficulties, back injury and referred leg pain as chief complaints were associated with greater chance of detecting potentially clinically positive lumbar MR image findings, as compare with simple back pain. There was no difference in positive rates among orthopedic surgeon and specialists of other disciplines. Lumbar spine MR imaging was generally overused in Eastern China by various specialists, particularly at health assessment centers. For appropriate use of lumbar spine MR, orthopedic surgeons are no better than physicians of other disciplines. Professional training and clinical guidelines are needed to facilitate evidence-based back pain practice in China.
Highlights
Back pain is a worldwide health problem in adults [1]
We retrospectively studied a large sample of lumbar spine MRIs in Eastern China to investigate the appropriateness of lumbar spine Magnetic resonance (MR) imaging and further to determine associated factors
We aimed to include the vast majority of lumbar spine MR imaging conducted in Hangzhou city on the January of 2013
Summary
Back pain is a worldwide health problem in adults [1]. The costly diagnostic imaging and clinical interventions for back pain add considerable burden on health care systems in many countries [2]. Only a small portion of back pain patients could be precisely diagnosed with pathoanatomical findings [1]. Radiologic study, is of limited value, if past history and clinical evaluation are not suggestive of a serious underlying pathology. Magnetic resonance (MR) imaging, which is able to provide a clear three-dimensional visualization of spinal structures, is regarded as the best non-invasive approach to detect lumbar pathologies. The most common findings on MR images perhaps are degenerative changes of the lumbar spine, such as disc degeneration, disc herniation, spinal canal stenosis, and facet
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