Spine MRI for Some Back Pain Added to Choosing Wisely List

North American Spine Society (NASS) adds advanced medical imaging for some back pain to list of questionable procedures kept by the American Board of Internal Medicine (ABIM) Choosing Wisely initiative. The NASS's multidisciplinary task force that developed the recommendations examined scientific evidence, existing clinical practice recommendations and expert opinion and came to the conclusion that it was necessary to issue a strong recommendation against ordering advanced imaging (e.g., MRI) of the spine within the first six weeks in patients "with non-specific acute low back pain in the absence of red flags." The recommendation against advanced medical imaging in these patients was at the top of the NASS list. It also recommended four other steps to reduce the over utilization of medicine. They were:

1. Don’t perform elective spinal injections without imaging guidance, unless contraindicated.
2. Don’t use bone morphogenetic protein (BMP) for routine anterior cervical spine fusion surgery.
3. Don’t use electromyography (EMG) and nerve conduction studies (NCS) to determine the cause of axial lumbar, thoracic or cervical spine pain.
4. Don’t recommend bed rest for more than 48 hours when treating low back pain.

The final list was reviewed and approved by the NASS Board of Directors. The society is one of 50 medical groups and organizations that have promised to add to the Choosing Wisely list over the next two years. The American College of Radiology is not among these groups, but it had perviously contributed recommendations to the list.