*Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA; and †University of Massachusetts, Lowell, MA.
Spine (Phila Pa 1976). 2013 Oct 15;38(22):1939-46. doi: 10.1097/BRS.0b013e3182a42eb6.
Retrospective cohort study.
To determine the effect of early (receipt ≤30 d postonset) magnetic resonance imaging (MRI) on disability and medical cost outcomes in patients with acute, disabling, work-related low back pain (LBP) with and without radiculopathy.
Evidence-based guidelines suggest that, except for "red flags," MRI is indicated to evaluate patients with persistent radicular pain, after 1 month of conservative management, who are candidates for surgery or epidural steroid injections. Prior research has suggested an independent iatrogenic effect of nonindicated early MRI, but it had limited clinical information and/or patient populations.
A nationally representative sample of workers with acute, disabling, occupational LBP was randomly selected, oversampling those with radiculopathy diagnoses (N = 1000). Clinical information from medical reports was used to exclude cases for which early MRI might have been indicated, or MRI occurred more than 30 days postonset (final cohort = 555). Clinical information was also used to categorize cases into "nonspecific LBP" and "radiculopathy" groups and further divided into "early-MRI" and "no-MRI" subgroups. The Cox proportional hazards model examined the association of early MRI with duration of the first episode of disability. Multivariate linear regression models examined the association with medical costs. All models adjusted for demographic and medical severity measures.
In our sample, 37% of the nonspecific LBP and 79.9% of the radiculopathy cases received early MRI. The early-MRI groups had similar outcomes regardless of radiculopathy status: much lower rates of going off disability and, on average, $12,948 to $13,816 higher medical costs than the no-MRI groups. Even in a subgroup with relatively minimal disability impact (≤30 d of total lost time post-MRI), medical costs were, on average, $7643 to $8584 higher in the early-MRI groups.
Early MRI without indication has a strong iatrogenic effect in acute LBP, regardless of radiculopathy status. Providers and patients should be made aware that when early MRI is not indicated, it provides no benefits, and worse outcomes are likely.
回顾性队列研究。
确定在伴有和不伴有根性病变的急性、致残性、与工作相关的下腰痛（LBP）患者中，早期（发病后≤30 天）磁共振成像（MRI）对残疾和医疗费用结果的影响。
循证指南建议，除“红色标志”外，对于持续神经根痛且经过 1 个月保守治疗后适合手术或硬膜外类固醇注射的患者，MRI 用于评估具有根性病变的患者。先前的研究表明，非适应证的早期 MRI 有独立的医源性作用，但它的临床信息和/或患者人群有限。
随机选择了患有急性、致残性、职业性 LBP 的具有全国代表性的工人样本，并对根性病变诊断进行了过采样（N=1000）。使用医疗报告中的临床信息排除了可能需要早期 MRI 的病例，或 MRI 发生在发病后 30 天以上的病例（最终队列=555）。临床信息还用于将病例分为“非特异性 LBP”和“根性病变”组，并进一步分为“早期-MRI”和“无-MRI”亚组。Cox 比例风险模型检查了早期 MRI 与首次残疾持续时间的关联。多元线性回归模型检查了与医疗费用的关联。所有模型均调整了人口统计学和医疗严重程度指标。
在我们的样本中，37%的非特异性 LBP 和 79.9%的根性病变病例接受了早期 MRI。早期-MRI 组无论根性病变状况如何，结果相似：残疾率明显降低，平均医疗费用比无-MRI 组高 12948 至 13816 美元。即使在残疾影响相对较小的亚组（MRI 后总失时≤30 天），早期-MRI 组的平均医疗费用也高出 7643 至 8584 美元。
在急性 LBP 中，即使没有适应证，早期 MRI 也有很强的医源性作用，无论根性病变状况如何。应让提供者和患者意识到，当早期 MRI 无适应证时，它没有任何益处，而且可能导致更差的结果。
3 级。
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