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- December (11)
- Cranberries vs. Antibiotics for UTI
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- Back Surgery: Too Many, Too Costly, Too Ineffective!
- Simvastin (Zocor, Vytorin, Simcor) Danger
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- Anti-coagulant Drug Problems
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- Antibiotics: Inappropriately Used
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- Pediatric Antibiotis: Over Prescribed?
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MRI Before Epidural Steroid Injections?
In patients with lumbosacral radiculopathy, MRI might not affect outcomes substantially, but it can aid planning of injections.
Low back pain is very common, and many patients receive routine spinal imaging (lumbar radiography, computed tomography, or magnetic resonance imaging [MRI]) despite evidence-based recommendations from the American College of Physicians (ACP) and the American Pain Society (APS) to perform imaging only for patients who have a severe progressive neurological deficit, signs or symptoms that suggest a serious or specific underlying condition (e.g., cancer), or who are candidates for an invasive intervention (Ann Intern Med 2011; 154:181). Various nonsurgical procedures are used for treatment of low back pain. For sciatica or prolapsed lumbar disk with radiculopathy, evidence suggests that epidural steroid injection (ESI) is moderately effective for short-term but not long-term relief of symptoms. The ACP/APS guidelines recommend obtaining MRI before consideration of ESIs. To examine whether MRI affects decision making about and outcomes of ESI in these patients, researchers randomized 132 patients with signs and symptoms of lumbosacral radiculopathy clinically warranting ESI to two groups. In group 1, participants all received ESIs; MRI was performed to rule out conditions that would preclude ESI, but the treating physician was blinded to the MRI findings. In group 2, the physician determined treatment based on clinical findings and imaging results. Treatment success was defined as a 2-point or greater improvement in leg pain plus no need for further intervention.
The two groups demonstrated roughly similar improvements in leg pain, back pain, and disability at 1 and 3 months. The 3-month rate of overall treatment success was modest: 35% in group 1 and 41% in group 2. However, ESI at the same spinal level as that indicated by the MRI finding was significantly more successful than injection at another spinal level (42% vs. 23%).
Comment: Although the overall results of this study were negative, they suggest a small benefit to using MRI to guide epidural steroid injection planning in patients with lumbar radiculopathy. These results support the existing guideline recommendation to obtain an MRI before performing epidural steroid injections.
Epidural Steroid Injections are usually used for herniated discs. Herniated discs are only seen on MRI. The level of herniation can be predicted but not confirmed unless an MRI or discogram is obtained. Why would anyone want to have a steroid injection (which only provides temporary relief at best) without confirmation of a disc problem and the level of the herniation?