Effect of MRI on treatment results or decision making in patients with lumbosacral radiculopathy referred for epidural steroid injections: A multicenter, randomized controlled trial

Steven P. Cohen, Anita Gupta, Scott A. Strassels, Paul J. Christo, Michael A. Erdek, Scott R. Griffith, Connie Kurihara, Chester C. Buckenmaier, David Cornblath, To Nhu Vu

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Studies have shown that radiologic imaging does not improve outcomes in most patients with back pain, though guidelines endorse it before epidural steroid injections (ESIs). The objective of this study was to determine whether magnetic resonance imaging (MRI) improves outcomes or affects decision making in patients with lumbosacral radiculopathy referred for ESI. Methods: In this multicenter randomized study, the treating physician in group 1 patients was blinded to the MRI results, while the physician for group 2 patients decided on treatment after reviewing the MRI findings. In group 1 subjects, an independent physician proposed a treatment plan after reviewing the MRI, which was compared with the treatment the patient received. Results: Slightly lower leg pain scores were noted in the group 2 at 1 month compared with MRI-blinded patients in group 1 (mean scores, 3.6 vs 4.4) (P=.12). No differences were observed in pain scores or function at 3 months. Overall, the proportion of patients who experienced a positive outcome was similar at all time points (35.4% at 3 months in group 1 vs 40.7% in group 2). Among subjects in group 1 who received a different injection than that proposed by the independent physician, scores for both leg pain (4.8 vs 2.4) (P=.01) and function (38.7 vs 28.2) (P=.04) were inferior to patients whose injection correlated with imaging. Collectively, 6.8% of patients did not (group 2) or would not have (group 1) received an ESI after the MRI was reviewed. Conclusion: Magnetic resonance imaging does not improve outcomes in patients who are clinical candidates for ESI and has only a minor effect on decision making. Trial Registration: clinicaltrials.gov Identifier: NCT00826124.

Original languageEnglish (US)
Pages (from-to)134-142
Number of pages9
JournalArchives of Internal Medicine
Volume172
Issue number2
DOIs
StatePublished - Jan 23 2012

Fingerprint

Epidural Injections
Radiculopathy
Decision Making
Randomized Controlled Trials
Steroids
Magnetic Resonance Imaging
Physicians
Therapeutics
Pain
Leg
Injections
Back Pain
Multicenter Studies
Guidelines

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Cohen, Steven P. ; Gupta, Anita ; Strassels, Scott A. ; Christo, Paul J. ; Erdek, Michael A. ; Griffith, Scott R. ; Kurihara, Connie ; Buckenmaier, Chester C. ; Cornblath, David ; Vu, To Nhu. / Effect of MRI on treatment results or decision making in patients with lumbosacral radiculopathy referred for epidural steroid injections : A multicenter, randomized controlled trial. In: Archives of Internal Medicine. 2012 ; Vol. 172, No. 2. pp. 134-142.
@article{7641b527618e44adb970b8b2dfca5646,
title = "Effect of MRI on treatment results or decision making in patients with lumbosacral radiculopathy referred for epidural steroid injections: A multicenter, randomized controlled trial",
abstract = "Background: Studies have shown that radiologic imaging does not improve outcomes in most patients with back pain, though guidelines endorse it before epidural steroid injections (ESIs). The objective of this study was to determine whether magnetic resonance imaging (MRI) improves outcomes or affects decision making in patients with lumbosacral radiculopathy referred for ESI. Methods: In this multicenter randomized study, the treating physician in group 1 patients was blinded to the MRI results, while the physician for group 2 patients decided on treatment after reviewing the MRI findings. In group 1 subjects, an independent physician proposed a treatment plan after reviewing the MRI, which was compared with the treatment the patient received. Results: Slightly lower leg pain scores were noted in the group 2 at 1 month compared with MRI-blinded patients in group 1 (mean scores, 3.6 vs 4.4) (P=.12). No differences were observed in pain scores or function at 3 months. Overall, the proportion of patients who experienced a positive outcome was similar at all time points (35.4{\%} at 3 months in group 1 vs 40.7{\%} in group 2). Among subjects in group 1 who received a different injection than that proposed by the independent physician, scores for both leg pain (4.8 vs 2.4) (P=.01) and function (38.7 vs 28.2) (P=.04) were inferior to patients whose injection correlated with imaging. Collectively, 6.8{\%} of patients did not (group 2) or would not have (group 1) received an ESI after the MRI was reviewed. Conclusion: Magnetic resonance imaging does not improve outcomes in patients who are clinical candidates for ESI and has only a minor effect on decision making. Trial Registration: clinicaltrials.gov Identifier: NCT00826124.",
author = "Cohen, {Steven P.} and Anita Gupta and Strassels, {Scott A.} and Christo, {Paul J.} and Erdek, {Michael A.} and Griffith, {Scott R.} and Connie Kurihara and Buckenmaier, {Chester C.} and David Cornblath and Vu, {To Nhu}",
year = "2012",
month = "1",
day = "23",
doi = "10.1001/archinternmed.2011.593",
language = "English (US)",
volume = "172",
pages = "134--142",
journal = "JAMA Internal Medicine",
issn = "2168-6106",
publisher = "American Medical Association",
number = "2",

}

Effect of MRI on treatment results or decision making in patients with lumbosacral radiculopathy referred for epidural steroid injections : A multicenter, randomized controlled trial. / Cohen, Steven P.; Gupta, Anita; Strassels, Scott A.; Christo, Paul J.; Erdek, Michael A.; Griffith, Scott R.; Kurihara, Connie; Buckenmaier, Chester C.; Cornblath, David; Vu, To Nhu.

In: Archives of Internal Medicine, Vol. 172, No. 2, 23.01.2012, p. 134-142.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of MRI on treatment results or decision making in patients with lumbosacral radiculopathy referred for epidural steroid injections

T2 - A multicenter, randomized controlled trial

AU - Cohen, Steven P.

AU - Gupta, Anita

AU - Strassels, Scott A.

AU - Christo, Paul J.

AU - Erdek, Michael A.

AU - Griffith, Scott R.

AU - Kurihara, Connie

AU - Buckenmaier, Chester C.

AU - Cornblath, David

AU - Vu, To Nhu

PY - 2012/1/23

Y1 - 2012/1/23

N2 - Background: Studies have shown that radiologic imaging does not improve outcomes in most patients with back pain, though guidelines endorse it before epidural steroid injections (ESIs). The objective of this study was to determine whether magnetic resonance imaging (MRI) improves outcomes or affects decision making in patients with lumbosacral radiculopathy referred for ESI. Methods: In this multicenter randomized study, the treating physician in group 1 patients was blinded to the MRI results, while the physician for group 2 patients decided on treatment after reviewing the MRI findings. In group 1 subjects, an independent physician proposed a treatment plan after reviewing the MRI, which was compared with the treatment the patient received. Results: Slightly lower leg pain scores were noted in the group 2 at 1 month compared with MRI-blinded patients in group 1 (mean scores, 3.6 vs 4.4) (P=.12). No differences were observed in pain scores or function at 3 months. Overall, the proportion of patients who experienced a positive outcome was similar at all time points (35.4% at 3 months in group 1 vs 40.7% in group 2). Among subjects in group 1 who received a different injection than that proposed by the independent physician, scores for both leg pain (4.8 vs 2.4) (P=.01) and function (38.7 vs 28.2) (P=.04) were inferior to patients whose injection correlated with imaging. Collectively, 6.8% of patients did not (group 2) or would not have (group 1) received an ESI after the MRI was reviewed. Conclusion: Magnetic resonance imaging does not improve outcomes in patients who are clinical candidates for ESI and has only a minor effect on decision making. Trial Registration: clinicaltrials.gov Identifier: NCT00826124.

AB - Background: Studies have shown that radiologic imaging does not improve outcomes in most patients with back pain, though guidelines endorse it before epidural steroid injections (ESIs). The objective of this study was to determine whether magnetic resonance imaging (MRI) improves outcomes or affects decision making in patients with lumbosacral radiculopathy referred for ESI. Methods: In this multicenter randomized study, the treating physician in group 1 patients was blinded to the MRI results, while the physician for group 2 patients decided on treatment after reviewing the MRI findings. In group 1 subjects, an independent physician proposed a treatment plan after reviewing the MRI, which was compared with the treatment the patient received. Results: Slightly lower leg pain scores were noted in the group 2 at 1 month compared with MRI-blinded patients in group 1 (mean scores, 3.6 vs 4.4) (P=.12). No differences were observed in pain scores or function at 3 months. Overall, the proportion of patients who experienced a positive outcome was similar at all time points (35.4% at 3 months in group 1 vs 40.7% in group 2). Among subjects in group 1 who received a different injection than that proposed by the independent physician, scores for both leg pain (4.8 vs 2.4) (P=.01) and function (38.7 vs 28.2) (P=.04) were inferior to patients whose injection correlated with imaging. Collectively, 6.8% of patients did not (group 2) or would not have (group 1) received an ESI after the MRI was reviewed. Conclusion: Magnetic resonance imaging does not improve outcomes in patients who are clinical candidates for ESI and has only a minor effect on decision making. Trial Registration: clinicaltrials.gov Identifier: NCT00826124.

UR - http://www.scopus.com/inward/record.url?scp=84863393438&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84863393438&partnerID=8YFLogxK

U2 - 10.1001/archinternmed.2011.593

DO - 10.1001/archinternmed.2011.593

M3 - Article

C2 - 22157067

AN - SCOPUS:84863393438

VL - 172

SP - 134

EP - 142

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

SN - 2168-6106

IS - 2

ER -