Abstract
Diagnostic imaging in LBP is controversial. Concerns relate to costs and “creating potential barriers to recovery”.
Methods: All GPs in north Bristol (population 250,000) submitted every non-emergency referral for LBP+/−sciatica to our office, as a “single point of entry” clinic. 1301 patients have been assessed, 1283 with MRI screening.
We calculated proportions of MRI diagnoses and treatment pathways, and compared these with routine care (the pre-existing service, having comparable protocols, other than MRI screening.
Results: Summary of MRI diagnoses - potential surgical spine pathology 519(40.5%) (disc prolapse=295, stenosis=148, spondylolisthesis=49, other=27); serious pathology (tumours, aortic aneurysms) 12(0.94%); spondylosis 681(53%); no degenerative change- 71(5.5%).
Only 149(11.6%) of patients needed follow-up in clinic (30–58% in routine care). Overall, 637(49.6%) patients were managed in primary care, and 646(50.4%) were referred to secondary care, including 161(12.5%) referred for surgery, comparable to routine care (12–16% surgery), and 406(31.6%) patients referred to consultant pain physicians.
Discussion: In the new service, time from referral to diagnosis/treatment planning reduced from 12–16 weeks to three weeks. MRI screening did not increase referrals for surgery. Costs were minimised by leasing downtime on NHS scanners, with dedicated lumbar spine sessions leading to increased scans per hour. Very low follow-up rate further reduced costs.
The use of MRI as a tool to advise LBP patients on the spectrum of management options is arguably the way of the future. We would however, not recommend this without subsequent clinical review by an experienced clinician, including a discussion about the relevance of the findings.
Conflicts of Interest: None
Source of Funding: None
Correspondence should be addressed to: SBPR at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
