UMEM Educational Pearls

Category: Orthopedics

Title: "I have sciatica, I want a MRI and I want it now"

Keywords: Sciatica, radiculopathy, imaging (PubMed Search)

Posted: 9/19/2014 by Brian Corwell, MD (Emailed: 9/27/2014) (Updated: 9/27/2014)
Click here to contact Brian Corwell, MD

Back pain with radiculopathy can be very distressing to a patient and they have heard from their medically savvy neighbor that a MRI is the way to go. Now, armed with this knowledge, they are in your ED with earplugs in hand...

A few minutes of reassurance and education can save in both cost and ED throughput.

In one study researchers performed MRIs on asymtomatic adult patients.

               Almost two-thirds (64%) had abnormal discs

               Just over half (52%) had bulging discs

               Almost a third (31%) had disc protrusions

Further, finding a bulging disc already suggested by your history and physical examination does not change management. The majority of these patients improve with conservative treatment within four to to six weeks.

Restrict ED MRI use for the evaluation of suspected cauda equina, epidural abscess and spinal cord compression.