If you have lower back pain should you have a lumbar spine MRI?

Lumbar spine MRI is often offered to people with lower back pain but these recently published guidelines suggest that it is not always needed. These guidelines have been published by NICE1 and describe the best treatment for lower back pain in people who have had back pain for more than one week but less than one year.

In this article

About the guidelines for the treatment for back pain
Recommended treatment for lower back pain
What to avoid when treating lower back pain
Lumbar spine MRI scan and other tests

Is it a good idea to have an X-ray or MRI scan?

The guidelines say no. They say that X-ray of the lumbar spine should not be offered and that lumbar spine MRI should only be arranged if the person with back pain is a very likely candidate for lumbar spine surgery such as a spinal fusion.

The only other reason for undergoing an MRI scan is if the doctor suspects you have a serious back problem such as cancer, infection, inflammatory disease e.g. ankylosing spondylitis, cauda equina or fractures.

The research supporting this advice has been around for a while now, many studies have shown there is little benefit in having these tests for the majority of people with back pain. You can see more references for this in this page on lower back pain investigations.

Despite this guidance millions of unnecessary scans and x-rays are undertaken every year. This is partly due to patient pressure – many people feel an MRI is needed so that they can know 'exactly what is going on inside'. The scans can indeed be reassuring but more often then not they show up regular changes that have been shown to exist in people regardless if they have back pain or not. Sometimes these normal findings can be an additional source of worry. My advice would be to have frank discussions with your doctor about the usefulness of these types of tests if you have had back pain for less than a year, if nothing serious is suspected and you are not a candidate for surgery.