When is an MRI indicated for patient's with low back pain?

Many of our low back pain patients will request that we order an MRI (magnetic resonance imaging). We often spend a bit of time explaining why an MRI is not necessarily necessary to treat a low back condition. As a general rule of thumb, we recommend this advanced (and expensive; over $1000.00) imaging in the following instances:

1. When there is a reasonable risk for cancer or infection
2. When a patient is developing progressive neurological impairment (loss of strength, loss of sensation or pain along the course of a nerve)
3. When we are considering "needles or knives". That is, when we are considering referring a patient for a spinal injection or surgery.

The following are not necessarily an indication for an MRI:

1. Chronic low back pain
2. Sciatic pain that is (a) not worsening, or (b) is getting better