Lumbar MRI: Patient Understanding & Provider Accountability

Many published studies over the past decade recommend caution in ordering magnetic resonance imaging ("MRI") scans for low back pain. Clinicians, especially those with family medicine training, have been slow to adapt, and injured workers pay the price with misunderstandings and worse outcomes. 

The first study on patient/consumer comprehension of imaging reports requested for low back pain was published in BMJ Open (a leading multidisciplinary medical journal) in September 2021. The goal of the study was to assess patient self-reported comprehension of the language in medical imaging reports.  This study also considers how that understanding (or lack thereof) impacts the patient’s perceived seriousness of spine conditions, the likely persistence of low back pain, fear of movement, back beliefs, and intensity of low back pain. 

The terms assessed in the report included disc degeneration/extrusion, annular fissure, disc protrusion, facet degeneration, and spinal stenosis. 

According to the authors, patient/consumer self-reported understanding of all terms was poor and the misunderstandings pose major risks for overdiagnosis and overtreatment of low back pain. The timing of this study is significant because patients in the U.S. have had complete and free access to their medical records, including imaging reports, since April 2021. 

Takeaways: Lumbar MRI’s should be reserved only to diagnose serious conditions requiring immediate intervention and for patients being considered for surgery for persistent neurological dysfunction. At OccMD, we strive to provide continued physician and mid-level provider education on the appropriate indications for lumbar MRI’s and the timing of that imaging, as well as the interpretation of imaging reports, and how to effectively communicate the report findings to injured workers when the imaging abnormalities reflect normal, age-related changes. 

By Melissa D. Tonn, MD, MBA, MPH, OccMD Chief Medical Officer