x-ray

Are X-Rays, MRIs, & CT Scans Helpful in Treating Back Pain?

/ Thomas Cohn, MD

spine x-rayOne of the most common concerns of someone with low back pain is whether they need X-Rays or special scans such as a CT or MRI study.  Usually, the answer is no. Most low back pain will resolve in weeks to a month or two with conservative care.  For normal back conditions, imaging is not necessary to guide care and is needed only in a few circumstances. In this article, we will outline the three major imaging methods (X-Rays, MRIs, CTs) and discuss when each is recommended.

X-Rays

Plain X-rays of the lumbar spine can show all of the following:

  • Alignment and curvature
  • Disc space
  • Bones

X –rays are helpful when there is acute trauma to the spine and fractures are a concern.  In children, where scoliosis is suspected, plain films of the spine are also helpful.  In normal adults without the above 2 conditions, X-rays show very little information that is useful in managing low back pain.  Chiropractic films of curvature do not contribute to management decisions in back pain, and just expose one to unnecessary radiation.

MRI Scans

MRI scans of the lumbar spine can give good detailed information with regards to the following:

  • Bones
  • Discs
  • Ligaments
  • Nerves
  • Other abnormalities in this region

In reality, MRI scans are best for determining surgical or advanced conservative pain intervention.  If you have had a scan in the past, you probably wouldn’t need another one unless your physician suspects significant new changes such as cancer.

CT Scans

CT scans of the lumbar spine are very good at evaluating the bone structures, but are not as good when evaluating discs, muscles, and nerves.  They are used in cases of trauma, since a scan can be done quickly, in minutes.  CT scans are also used after surgery, or when the patient has implants that are not compatible with the magnets of an MRI scan.  These scans are also done only when significant changes are suspected and a surgery type intervention is being considered.

Rarely is imaging absolutely necessary in the management of low back pain.  Most low back pain heals rapidly with conservative treatment.  If the low back pain is not improving, then one should find a Physical Medicine and Rehabilitation specialist.