THE THERAPEUTIC IMPACT OF LUMBAR SPINE MRI ON PATIENTS WITH LOW-BACK AND LEG PAIN

The influence of lumbar spine magnetic resonance imaging (MRI) on the management of patients with low back and leg pain, with a clinical dia gnosis of neural compression, has been investigated by a controlled pr ospective observational study. The clinical features of the patients a t the time of request for MRT have been compared with the subsequent m anagement in order to define the clinical indications for lumbar spine MRI, Methods: Clinical history, physical examination findings and tes ts of functional and psychological disability were all recorded at the time of request for MRI, Following MRI, patients were assessed withou t knowledge of the MRI findings and a diagnosis and management plan re corded. Immediate access to the MRI report and hard copy films was the n provided and a revised diagnosis and management plan made. The clini cal features and MRI findings were compared with the subsequent manage ment. Results: Seventy-two patients were examined, 65 (90.3%) had leg pain as a predominant feature and abnormalities in neurological examin ation were found in 31 (43%). Twenty-three of 48 (47.9%) of patients w ith a pre MRI management plan of surgery were changed to conservative management following the MRI. The diagnosis altered in 50% of cases wi th the largest change in diagnosis occurring in 13 patients where MRI did not confirm the clinical impression of nerve root compression. Sev enteen patients with no abnormality of neurological testing were subse quently treated by surgery which included all 12 patients treated by s pinal fusion, Conclusions: The major impact of MRI was to move patient s towards conservative treatment. A variety of features in the history and physical examination as well as MRT findings are predictors for s urgical treatment. The variety of diagnoses and surgical options avail able make it difficult to define clear clinical guidelines for the use of MRI.