Patients reporting new low-back pain are more likely to undergo surgery if treated in an area with a higher-than-average concentration of magnetic resonance imaging machines, according to research from the Stanford University School of Medicine. This may be bad news for patients, since previous studies have found that increased surgery rates don't improve patient outcomes. "The worry is that many people will not benefit from the surgery, so heading in this direction is concerning," said senior author Laurence Baker, PhD, professor of health research and policy. In their new study, to be published online Oct. 14 in Health Affairs, Baker and first author Jacqueline Baras correlate areas with high numbers of MRI machines to an increased likelihood that MRIs will be performed on new low-back pain patients. In turn, high local MRI availability correlates with increased rates of low-back surgery. "It is important that policymakers recognize that infrastructure matters, and that the number of MRI machines in any particular area may affect the volume and quality of health care that patients receive," said Baras, a Stanford medical student with a master's degree in health services research. Low-back pain was the fifth-most common reason for physician visits in the United States, with 26.4 percent of adults reporting low-back pain for a day or more during a three-month period in 2002. More than 80 percent of low-back pain was diagnosed as nonspecific, a category that includes lumbar strains and sprains, degenerative disk disease and spinal instability. MRIs visualize the body's internal structure and allow doctors to rule out some specific causes of back pain. However, MRIs may also detect anomalies unrelated to back pain, prompting doctors to perform surgery that may not benefit the patient, the authors noted.
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