MRI abundance may lead to excess in back surgeries, researchers say

Individuals reporting new low back pain are more likely to undergo surgery if treated in an area with a higher-than-average concentration of magnetic resonance imaging machines, according to a recent study.

Researchers from the Stanford University School of Medicine said the findings may be troubling news for patients since previous studies have found that increased surgery rates don't always improve outcomes.

"The worry is that many people will not benefit from the surgery, so heading in this direction is concerning," said Laurence Baker, senior author of the study and professor of health research and policy at the school.

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In the report, published in a recent issue of Health Affairs, researchers correlated areas with high numbers of MRI machines to an increased likelihood that MRIs will be performed on new low back pain patients. In turn, high local MRI availability correlated with increased rates of low back surgery.

About the study. MRIs visualize the body's internal structure and allow doctors to rule out some specific causes of back pain. However, MRIs may also detect anomalies unrelated to back pain, prompting doctors to perform surgery that may not benefit the patient, the authors noted.

To determine how MRI technology influences patient treatment, the researchers collected data on traditional Medicare patients who received care for nonspecific low back pain from 1998 through 2005. Patient data were linked with the number of MRI machines in the area. The areas of MRI availability were then divided into four groups, from high to low, and the incidence of MRI scans and surgeries were determined in each group.

Researchers projected that in 2004 there would have been 5.4 percent fewer low back MRIs and 9 percent fewer back surgeries if all Medicare patients reporting new-onset low back pain had been living in the areas of lowest MRI availability.

Researchers found that two-thirds of the MRI scans that appear to result from increased availability happened within the first month of onset. Clinical guidelines recommend delaying MRI use until four weeks after onset during which time most low back pain patients show spontaneous improvement.

"Not only are patients in high-availability areas getting more MRIs, but they are getting them earlier," said Jacqueline Baras, a Stanford medical student with a master's degree in health services research.

The study noted that between 2000 and 2005, the MRI availability in the United States more than tripled, from 7.6 machines per 1 million persons to 26.6 machines per 1 million individuals. Each machine costs more than $2 million and one low back scan costs $1,500. Increased rates of scans and surgeries are increasing the cost to treat low back pain, the authors said.

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December 21, 2009

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