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The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting’: results from an RCT and blinded trials



Inappropriate use of MRI leads to increasing interventions and surgeries for low back pain (LBP). We probed the potential effects of a routine MRI report on the patient’s perception of his spine and functional outcome of treatment. An alternate ‘clinical reporting’ was developed and tested for benefits on LBP perception.


In Phase-I, 44 LBP patients were randomized to Group A who had a factual explanation of their MRI report or Group B, who were reassured that the MRI findings showed normal changes. The outcome was compared at 6 weeks by VAS, PSEQ-2, and SF-12. In Phase-II, clinical reporting was developed, avoiding potential catastrophizing terminologies. In Phase-III, 20 MRIs were reported by both routine and clinical methods. The effects of the two methods were tested on four categories of health care professionals (HCP) who read them blinded on their assessment of severity of disease, possible treatment required, and the probability of surgery.


Both groups were comparable initial by demographics and pain. After 6 weeks of treatment, Group A had a more negative perception of their spinal condition, increased catastrophization, decreased pain improvement, and poorer functional status(p = significant for all). The alternate method of clinical reporting had significant benefits in assessment of lesser severity of the disease, shift to lesser severity of intervention and surgery in three groups of HCPs.


Routine MRI reports produce a negative perception and poor functional outcomes in LBP. Focussed clinical reporting had significant benefits, which calls for the need for ‘clinical reporting’ rather than ‘Image reporting’.

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All authors had significant contribution for the study. SR conceptualised and oversaw the study with writing of the manuscript. DCR was involved in conducting the study and preparing the manuscript. PBT was involved in Phase-II and Phase-III and was instrumental in devising enhanced method of reporting. RMK and APS provided the clinical inputs and participated in manuscript preparation.


The project was funded by Ganga Orthopaedic Research & Education Foundation (GOREF 2016–07).

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Correspondence to S. Rajasekaran.

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The study was performed after approval of the IRB committee.

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Rajasekaran, S., Dilip Chand Raja, S., Pushpa, B.T. et al. The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting’: results from an RCT and blinded trials. Eur Spine J 30, 2069–2081 (2021).

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  • Low back pain
  • MRI reports
  • Catastrophization
  • Clinical reporting
  • Nocebo effect