Study finds no benefit, increased cost with early imaging for back pain in older adults

Older adults who underwent spine imaging within six weeks of a primary care visit for back pain had outcomes over the following year that were no different than other patients who had no imaging, according to a study in the March 17 issue of JAMA.

According to the authors, led by Jeffrey G. Jarvik, MD, of the University of Washington, decisions about when to image older adults with back pain remain controversial, with some guidelines recommending that older adults undergo early imaging because of the prevalence of underlying conditions in that population.

The potential problem with this strategy, according to the authors, is that the high prevalence of age-related changes increase with age and may or may not be related to someone’s back pain. Consequently, early imaging of adults could result in incidental findings leading to interventions with poor outcomes and increased healthcare costs with no associated benefit.

In this prospective study, Jarvik and his colleagues analyzed 5,239 patients 65 years or older with a new primary care visit for back pain (in three hospital systems) who didn’t have radiculopathy—a condition affecting the spinal nerve roots and spinal nerves.

According to Jarvik, these patients were matched with patients who were similar but didn’t have early imaging and measured with a focus on disability, pain, depression, anxiety and health-related quality of life.

Of those patients 1,174 had early radiographs, and 349 had early MRI or CT exams.  After 12 months, neither the group undergoing early radiographs, nor the group undergoing early MRI/CT differed significantly from patients who didn’t undergo early imaging concerning measures of back or leg pain-related disability.

But, according to the authors, there was a significant difference in resource allocation between the group that underwent early imaging and the group that didn’t. The costs associated with the early imaging group were $1,380 higher per patient with early radiographs and $1,430 higher for patients with early MRI/CTs.

“The take home message is that older adults really shouldn’t be treated any differently than younger adults with respect to imaging guidelines,” said Jarvik. “In the absence of red flags, early imaging does not help to improve their outcomes, but they do end up using a lot more health care services.”