AIM: Despite wide use, MRI may be unneeded before epidural steroid injection
While studies don’t support the use of radiologic imaging on patients with back pain, some guidelines endorse the use of MRI prior to ESI. Steven P. Cohen, MD, of Johns Hopkins School of Medicine in Baltimore, and colleagues conducted the multicenter randomized study to determine whether MRI provides a benefit to outcomes or decision making in patients with lumbosacral radiculopathy referred for ESI.
“Despite several studies demonstrating that advanced radiologic testing does not improve outcomes in patients with lower back pain, with or without radicular symptoms, the use of MRI in this context continues to soar,” wrote the authors.
“The lack of unequivocal guidelines on the use of MRI before ESI is somewhat unexpected, considering that ESI is the most frequently performed procedure in pain clinics throughout the U.S.”
A total of 132 patients were divided into two groups, with the physician treating group one being blinded to MRI results and the physician treating group two deciding on treatment after review of MRI findings. Another independent physician proposed a treatment plan for patients in group one after reviewing the MRI and that plan was compared with the treatment the patient actually received. Group one patients all received ESIs, while five in group two did not, at which point those patients exited the study.
Results showed that slightly lower leg pain scores were noted in group two at one month compared with the MRI-blinded patients in group one, but no differences were observed in pain scores or function at three months. The overall proportion of patients who experienced a positive outcome was similar at all time points.
Collectively, 6.8 percent of patients did not, in the case of group two, or would not have, in the case of group one, received an ESI after the MRI was reviewed, according to the authors.
“In conclusion, our results suggest that although MRI may have a minor effect on decision making, it is unlikely to avert a procedure, diminish complications or improve outcomes,” wrote the authors. “Considering how frequently ESIs are performed, not routinely ordering an MRI before a lumbosacral ESI may save significant time and resources.”