Appropriateness of magnetic resonance imaging of the lumbar spine orders for low back pain in a general hospital

Abstract

Introduction Inappropriate magnetic resonance imaging (MRI) for low back pain contributes to increased healthcare costs. The American College of Radiology (ACR) appropriateness criteria for low back pain is a guideline to reduce these unnecessary MRIs. Methods Retrospective study of the MRI lumbar spine performed for the investigation of low back pain in a General Hospital from 2016-2017. Divided into six clinical categories. (1) No Red Flags. (2) Low-velocity trauma, osteoporosis, elderly individuals, or chronic steroid use. (3) Suspicion of cancer, infection, or immunosuppression. (4) Failed conservative management. (5) Prior lumbar surgery. (6) Suspected cauda equina syndrome or neurological deficit. MRI findings are divided into 1) Critical findings of spinal cord/cauda equina compression, metastatic cancer, spinal epidural abscess, and vertebral osteomyelitis. 2) Significant findings of vertebral compression fracture or compression of the lumbar spinal nerves. 3) Non-specific findings with no compression of the lumbar spinal nerves and no critical findings. Results 670 MRI lumbar spine were performed. 25.3% in group (1) with 0% critical findings. 35.3% in group (2) with 4.6% critical findings. 5.8% in group (3) with 39.5% critical findings. 23.4% in group (4) with 0% critical findings. 2.8% in in group (5) with 0% critical findings. 7.3% in group (6) with 91.7% critical findings. Conclusion 25.3% of MRI lumbar spine performed were inappropriate based on the ACR criteria. Moreover, there were no critical findings in this group. The use of ACR appropriateness criteria can reduce unnecessary MRI lumbar spine for low back pain without compromising patient safety.