![]() ![]() Of note, the rate of spine MRI increased sharply at the same time as that of lumbar surgeries (7, 15).Ī meta-analysis of 6 randomized trials (6), which comprised 1804 patients with primarily acute or subacute low back pain and no clinical or historical features that suggested a specific underlying condition, found no differences between routine lumbar imaging (radiography, MRI, or CT) and usual care without routine imaging in terms of pain, function, quality of life, or overall patient-rated improvement ( Table 3). Imaging can lead to additional tests, follow-up, and referrals and may result in an invasive procedure of limited or questionable benefit. Imaging is an important driver of low back pain costs, not only because of the direct costs of the procedures ( Table 1) (12, 13) but also the downstream effects (14). Reducing unnecessary tests or ineffective treatments (11) is an obvious way to decrease the costs associated with low back pain. Low back pain also incurs high indirect costs due to lost productivity (10). This rate was higher than that observed for overall health expenditures. Average total health expenditures for patients with back and neck problems increased from $4795 per year in 1997 to about $6096 per year in 2005, an inflation-adjusted increase of 65% (in 2005 U.S. health care expenditures for low back pain were estimated at $90 billion (8). The overuse of imaging also contributes to the high and growing costs associated with low back pain. This is problematic, because routine imaging does not seem to improve clinical outcomes and exposes patients to unnecessary harms (6, 7). Low back pain is very common (1, 2), and many patients with low back pain receive routine spinal imaging (lumbar radiography, computed tomography, or magnetic resonance imaging ) (3, 4), despite evidence-based recommendations from the American College of Physicians (ACP) and the American Pain Society (APS) that call for imaging only for patients who have severe or progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition (5). ![]()
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