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

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

Published on Sep 25, 2014 and last reviewed on Nov 28, 2022   -  4 min read


An MRI scan is an imaging test that helps find the exact cause of lower back pain or neck pain. Read the article to know more.

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


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. Back pain and neck pain are common health complaints; almost everybody suffers from these problems. Most of the time, neck and back pain are not caused due to some serious problem or injury, and the cause can be easily diagnosed. Often lower back and neck pain gets better on its own with time. But sometimes, finding the exact cause of such pain is difficult. When nothing helps, an MRI scan comes to the rescue and helps find the exact cause of the pain by providing detailed images of the soft tissue around the spine. However, an MRI scan is usually recommended if there are warning signs along with 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 derangements from normal anatomy, including:

  • Disc herniation (rupture of fibrocartilagenous material which surrounds the intervertebral disc).

  • Spine infection.

  • Tumors of the spine, nerves, or spinal cord.

  • Changes in the intervertebral disc or soft tissue adjacent to the spine.

MRI is superior to a CT scan in evaluating disorders of the spine as regards nerve compression. However, sometimes a 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.

What Is the Importance of Warning Symptoms and Signs?

The vast majority of neck or low back pain sufferers will improve without surgery. Only about two percent 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 have as a history that may indicate a serious condition include:

  • Progressive and unrelenting pain that is not relieved with rest and worsens at night.

  • Progressive weakness of one or more extremities.

  • One of the legs feels numb and gets worse with time.

  • Difficulty in controlling urination, bowel movements, or erections.

  • Weight loss or fever associated with the pain.

  • Recent serious illness, especially cancer or infection.

  • Long-term use of steroids.

  • History of cancer.

  • Living in an area where tuberculosis is endemic.

  • Pain seen under the age of 16 years or over 50 years of age.

  • The onset of pain after significant trauma.

Signs seen during the examination which may indicate a serious condition include:

  • Numbness in the groin, genital, and anal area, called saddle anesthesia.

  • An enlarged bladder can indicate urinary retention.

  • Fever.

  • Weight gets reduced below average according to 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 the 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 serious thoracic problem can be hard to localize with a study of only the cervical or thoracic spine alone. Most MRI scans 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.

What Are the Risks of MRI Scan?

In rare cases, the dye used in MRI scans may cause severe allergic reactions or damage to the kidneys. The strong magnetic fields used during an MRI scan may cause heart pacemakers not to work well. However, newer pacemakers are MRI-compatible. Hence, it is important to check with a cardiologist whether the pacemakers are MRI-compatible. MRI scans can also make a metal piece inside the body to move. So, inform the technologist about any metal objects present in the body. Pregnant women should go for MRI scans.


MRI is generally recommended when relief from symptoms is not obtained after giving the first line of treatment. MRI is considered a gold standard for diagnosing the cause of a specific condition and planning treatment. MRI scans are often used in planning back or neck surgery. At times, MRI scans may help in assessing post-surgical healing and recovery.

Frequently Asked Questions


When Would an MRI Be Required for Neck Pain?

The following conditions may necessitate a doctor to order a neck MRI (magnetic resonance imaging): 
Neck ache that persists over time. 
Existence of ongoing discomfort in the legs, arms, and shoulders.
Having pain after engaging in vigorous exercise or strenuous activity.


When Could an MRI of the Neck or Back Be Expected?

A cervical spine MRI can find several disorders in the neck and upper back, including issues with the spinal cord, nerves, and disks, which are soft tissues within the spinal column.


When Should a Backache Patient Get an MRI?

If the doctor believes that the reason for the low back discomfort is something other than a simple muscle strain, they may advise getting an MRI. This may be the case if the patient's medical history and physical examination indicate the presence of a significant issue, such as a fracture, tumor, infection, or damage to the patient's nerves.


Will an MRI Reveal Neck Nerve Damage?

An impingement or pinching of a nerve as it leaves the spinal cord frequently manifests as neck or low back pain that spreads into the arms or legs. Before irreversible nerve damage occurs, an MRI may be able to spot structural lesions that may be pressing against the nerve and help treat the issue.


What Will a Lower Back Injury MRI Reveal?

A lumbar spine MRI can show various abnormalities in the lower back, including issues with the bones (vertebrae), soft tissues (such as the spinal cord), nerves, and disks.


Does the Whole Body of the Patient Go In for a Neck MRI?

The neck region may be covered with coils, unique devices that enhance image quality. The complete body of the patient will be slid into the magnet by the scanning table. Although they will not feel anything, they occasionally hear buzzing, pounding, clicking, and knocking noises during the scan.


How Soon Are MRI Results Considered Urgent?

The doctor typically receives complete results in one to two days. Even though the size and shape of a tissue or organ appear normal, an MRI can occasionally detect a problem in that tissue or organ.


Can a Person Be Given Sedation for an MRI?

Although general anesthesia is occasionally used, MRIs under anesthesia are often performed while the patient is sedated. Sedation is defined as being between being relaxed and being extremely sleepy but not entirely unconscious.


Why Are Patients Advised Not to Drink Water Before an MRI?

Patients are advised not to eat or drink before procedures to get better and clear images. Thus, making the result more accurate.


What Happens if an MRI Shows Something Abnormal?

An abnormal MRI indicates that the scan does not reveal a healthy organ. In addition to structural damage that could suggest an injury, the scanned image might also exhibit lesions, inflammation, swelling, and bleeding.


How Much Time Does an MRI Require?

Depending on the size of the area being scanned and the number of images being obtained, an MRI scan can take anywhere from 15 minutes to 90 minutes and is a painless procedure.


Why Does One Feel Strange After Having an MRI?

The powerful magnet of an MRI exerts pressure on fluid moving through the balance center of the inner ear, giving the impression of sudden or jerky movement. In addition, some MRI scans require a contrast agent injection (dye). As a result, specific tissues and blood arteries become more distinct and detailed. Side effects of the contrast agent include feeling or being ill.


What Happens if a Person Becomes Anxious During an MRI?

Claustrophobic patients may develop panic episodes during an MRI if they are not given suitable accommodations, which can cause uncomfortable symptoms like chills, sweat, an elevated heart rate, and difficulty breathing. As much as 5 % of the population suffers from claustrophobia, making it a prevalent condition.


What Serves as the MRI Scan Substitute?

A computed tomography (CT scan) may be suggested if a patient cannot have an MRI. Patients with pacemakers, metal implants, or other implanted devices should avoid getting an MRI because of the powerful magnet inside the machine. CT scans generate images of soft tissues and hard tissues like bones.

Article Resources

Last reviewed at:
28 Nov 2022  -  4 min read




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