Neurological Health

When is an MRI Necessary for Low Back Pain or Neck Pain?

Written by
Dr. Tony Magana
and medically reviewed by iCliniq medical review team.

Published on Sep 25, 2014 and last reviewed on Jul 19, 2019   -  3 min read

Abstract

Abstract

The decision of when to do an MRI for patients with low back or neck pain depends upon assessing the risk of a serious condition being present as revealed by warning symptoms in the history or signs in the physical examination.

When is an MRI Necessary for Low Back Pain or Neck Pain?

How does an MRI Machine Work?

Unlike traditional x-rays or computerized axial tomography otherwise known as CT Scan, MRI (Magnetic Resonance Imaging) does not use any radiation and thus as far as scientifically known, it is much safer than x-rays. The patient is placed in a very strong magnetic field which causes the hydrogen protons in the body to become excited and because the magnetic field applied is uniform, these protons become similarly aligned. The magnetic field is rapidly turned on and off repeatedly which causes the protons to relax and emit radiofrequency waves. From this change the MRI machine can compute a picture of the tissues of the body particularly the brain, spinal cord, major nerves and other soft tissues. MRI detects slight differences in water content in soft tissues to detect abnormalities.

What Abnormalities can an MRI detect?

The MRI can show derangments from normal anatomy including:

  • Disc herniation (rupture of fibrocartilagenous material which surrounds the intervertebral disc).
  • Spine infection.
  • Tumours of the spine, nerves, or spinal cord.
  • Compression of the nerves or spinal cord from hemorrhage (bleeding), fracture, infection, or tumour.
  • Changes in the intervertebral disc or soft tissue adjacent to the spine.

MRI is superior to CT Scan in evaluating disorders of the spine as regards nerve compression. However sometimes CT Scan is needed to evaluate fine detail in the vertebrae because cortical bone, the tough outer layer of bone, has a low water content.

The Importance of Warning Symptoms or Signs:

The vast majority of neck or low back pain sufferers will improve without surgery. Only about 2% will ever need an operation. A physician can usually determine the potential seriousness of a condition causing pain by obtaining a detailed history and performing a thorough examination. If there are no warning symptoms or signs in the history or physical findings suggestive of a dangerous condition, then for most patients an MRI is not necessary before a trial of conservative treatment for at least a month.

Symptoms that the patient experiences or has in the history which may indicate a serious condition include:

  • Progressive and unrelenting pain that is not relieved with rest and worse at night.
  • Progressive weakness of one or more extremities.
  • Difficulty in controlling urination, bowel movements, or in having erections.
  • Weight loss or fever associated with the pain.
  • Recent serious illness especially cancer or infection.
  • History of osteoporosis.
  • Long term use of steroids.
  • Living in an area where tuberculosis is endemic.
  • Pain in someone under the of age 16 yerars or over 50 years of age.
  • Onset of pain after significant trauma.

Signs on examination which may indicate a serious condition include:

  • Numbness in the groin, genital, and anal area called saddle anesthesia.
  • An enlarged bladder which can indicate urinary retention.
  • Fever.
  • Weight below average for height.
  • Increased reflexes, positive babinski sign (extension of the great toe when the sole is stimulated) or clonus (a repetitive contraction of the ankle joint on sudden stretching of the achilles tendon - a tendon of posterior leg) can indicate spinal cord compression.
  • Bilateral weakness or sensory loss.
  • Weakness in one or more extremities against minimal resistance or gravity.

Which Area of the Spine should be Studied?

Most of the time patients with cervical spine problems have neck pain and upper extremity complaints while those with lumbar spine problems have low back pain and lower extremity complaints but sometimes it is not so clear.

Pain at the level of the shoulder blades can come from the lower cervical spine or upper thoracic spine. Generally if it also radiates to the arm then it comes from the cervical spine. Pain from the lower thoracic region can be similar to pain from the lumbar spine. If there are significant signs of lower extremity weakness, increased reflexes, bladder, bowel, or sexual dysfunction in a setting where the patient complains of low back pain then it may be wise to do a thoracic MRI if the lumbar does not show the cause. Similarly a very low cervical problem or high thoracic problem be hard to localize with a study of only the cervical or thoracic spine alone.

Most MRIs of the cervical usually show the lower brain so lesions near the junction of the cervical spinal cord and brain are usually identified somewhat on cervical MRI.

To know the need to go for an MRI, consult a spine health specialist online --> https://www.icliniq.com/ask-a-doctor-online/spine-health-specialist

Last reviewed at:
19 Jul 2019  -  3 min read

RATING

89
Ask a QueryAsk a Query Consult by PhoneConsult by Phone Video ChatVideo Chat

Tags:

Related Questions & Answers


MRI shows 'intermediate signal intensity lesion in endometrial cavity.' What is it?

Query: Hello doctor,My mother aged 55 years got an MRI with an observation of 'intermediate signal intensity lesion noted in the endometrial cavity measuring 19x28x24, in the fundal body region with loss of endometrial interface. Tethering of sigmoid colon with distal ileal loops to the uterus in fundus re...  Read Full >>


Dr. Jimesh H Mavani
Obstetrician And Gynaecologist

Answer: Hello, Welcome to icliniq.com. With this report, there is a possibility of malignancy. Cancer of the uterus is more likely. Do CA 125 level, CT scan abdomen and pelvis, X-ray, sonography, PET scan and consult a gynecologist near you and also take an opinion from an oncosurgeon. Doctors will do o...  Read Full

How to check if the blood circulation to the head and neck is fine?

Query: Hi doctor, A physiotherapist did some manipulation with my neck and since then when I fall asleep at night, my arms, hands,¬†upper back (area just below the neck) and brain feels weird as if blood supply is cut. This happens several times during the night while I am sleeping and these symptoms go aw...  Read Full >>


Dr. Akshay Kumar Saxena
Orthopaedician And Traumatologist

Answer: Hello, Welcome to icliniq.com. You have mentioned pain and numbness in your upper limbs after manipulation was done by a physical therapist. You have also mentioned both upper limb involvement which is actually a surprise because normal spinal manipulations should not actually lead to this especia...  Read Full

MRI spine showed intramedullary mass at T4. Is it a cyst or malignancy?

Query: Hello doctor, I had an MRI of the thoracic spine and it showed an intramedullar mass at level T4. I was told it is likely to be a cyst and is not malignant. However, everything I have read online says that intramedullar lesions are almost always malignant and cysts are rare or maybe evidence of MS,...  Read Full >>


Dr. Lokesh
Orthopaedician And Traumatologist

Answer: Hello, Welcome to icliniq.com. Can you attach the MRI images and upload it so that I can see it? For more information consult a spine health specialist online --> https://www.icliniq.com/ask-a-doctor-online/spine-health-specialist  Read Full

Popular Articles Most Popular Articles

Do you have a question on Back Pain or Mri?

Ask a Doctor Online

* guaranteed answer within 4 hours.
Enter Your Health Query
You can upload files and images in the next step.

Fee:  

 


Disclaimer: All health articles published on this website is not intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek the advice from your physician or other qualified health-care providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website.