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European Spine Journal

, Volume 28, Issue 5, pp 937–950 | Cite as

Imaging versus no imaging for low back pain: a systematic review, measuring costs, healthcare utilization and absence from work

  • G. P. G. LemmersEmail author
  • W. van Lankveld
  • G. P. Westert
  • P. J. van der Wees
  • J. B. Staal
Review Article

Abstract

Purpose

Imaging (X-ray, CT and MRI) provides no health benefits for low back pain (LBP) patients and is not recommended in clinical practice guidelines. Whether imaging leads to increased costs, healthcare utilization or absence from work is unclear. Therefore, this study systematically reviews if imaging in patients with LBP leads to an increase in these outcomes.

Methods

We searched PubMed, CINAHL, EMBASE, Cochrane Library and Web of Science until October 2017 for randomized controlled trials (RCTs) and observational studies (OSs), comparing imaging versus no imaging on targeted outcomes. Data extraction and risk of bias assessment was performed independently by two reviewers. The quality of the body of evidence was determined using GRADE methodology.

Results

Moderate-quality evidence (1 RCT; n = 421) supports that direct costs increase for patients undergoing X-ray. Low-quality evidence (3 OSs; n = 9535) supports that early MRI may lead to an increase in costs. There is moderate-quality evidence (1 RCT, 2 OSs; n = 3897) that performing MRI or imaging (MRI or CT) is associated with an increase in healthcare utilization (e.g., future injections, surgery, medication, etc.). There is low-quality evidence (5 OSs; n = 15,493) that performing X-ray or MRI is associated with an increase in healthcare utilization. Moderate-quality evidence (2 RCTs; n = 667) showed no significant differences between X-ray or MRI groups compared with non-imaging groups on absence from work. However, low-quality evidence (2 Oss; n = 7765) did show significantly greater mean absence from work in the MRI groups in comparison with the non-imaging groups.

Conclusions

Imaging in LBP may be associated with higher medical costs, increased healthcare utilization and more absence from work.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Low back pain Imaging Costs Healthcare utilization Absence from work 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest

Supplementary material

586_2019_5918_MOESM1_ESM.pptx (288 kb)
Supplementary material 1 (PPTX 288 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Fysius Back ExpertsNijverdalThe Netherlands
  2. 2.Radboud Institute for Health Sciences, IQ HealthcareRadboud University Medical CenterNijmegenThe Netherlands
  3. 3.Research Group Musculoskeletal RehabilitationHAN University of Applied SciencesNijmegenThe Netherlands

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