I’m having back pain, do I need an MRI or X-ray? I sprained my ankle and it bruised terribly, do I need an X-ray? Was in a motor vehicle accident (MVA), do I need imaging?
The honest truth to most of the medical imaging questions is more than likely: not at all. In a systematic review (best form of a study) from 2015 (Brinjikji et al) with 3,110 individuals from age 20-80 y/o were placed in a CT or MR machine and scans were performed. Of these individuals, disc degeneration was found in 37% of 20 y/o, and 96% of 80 y/o. A disc bulge was found in 30% of 20 y/o and 84% of 80 y/o. A disc protrusion was found in 29% of 20 y/o and 43% in 80 y/o. An annular fissure was found in 19% of 20 y/o and 29% of 80 y/o. This study demonstrates and increase in spinal abnormalities from 20 to age 80, which seems pretty unsettling right?! Now, what if I told you that all of the 3110 people had NO PAIN or symptoms at all?!
But how can that be? Their medical imaging showed an “abnormal” spine clear as day. What this tells us is that the “abnormal” spine is more of the norm then what most people think. This is due to increased age, normal wear and tear and most importantly, your images is not always what defines your pain.
So, when is imaging appropriate? Medical imaging becomes appropriate when conservative measures have failed, your health provider finds red flags within your medicinal history, a traumatic event or a visible abnormality is noted and surgery may be imminent. When it comes to our joints or specific areas of our bodies, we have basic screening tools that give us high diagnostic accuracy on the need for clinical imaging.
For clinical rules on potential medicinal imaging see: Ankle Ottawa Rules, Ottawa Knee Rules, Canadian C-spine Rules or when following a traumatic event
Put your mind to rest! Your medicinal imaging doesn’t always define your pain and conservative cares are not only more than capable of treating your pain, but also to reduce assist in reducing your medical bills!
