Pertinence of magnetic resonance imaging in lumbar pain: a prospective surgeon-based evaluation of diagnostic concordance and therapeutic impact.

INTRODUCTION: Magnetic resonance imaging (MRI) is integral in diagnosing spinal disorders, yet it is often over-utilized, contributing to rising healthcare costs. The diagnostic match between surgeon’s assessment and MRI is unclear objectively. METHODS: Three spine surgeons prospectively evaluated 460 patients with lumbar axial/radicular pain, who required a MRI. Before MRI, each surgeon recorded the predicted need for MRI and its expected usefulness for treatment. After MRI, clinical and MRI diagnoses were compared and the factors correlating with correct clinical diagnosis and MRIs’ influence on treatment were analysed. RESULTS: The mean age of patients was 47.9 ± 16.3 years. Red flags were present in 52.2% and yellow flags in 12.8%. Surgeons expected the MRI to be definitely beneficial, and treatment not possible without MRI in 79.2%. Clinical and MRI diagnoses matched in 70.4% of cases (k = 0.432, p = 0.001). Combined axial & radicular pain (p = 0.041), symptoms > 6 months (p = 0.05), absence of other joint pain (p = 0.005), and red flags (p = 0.059) correlated significantly with clinical-MRI concordance. MRI influenced treatment decisions in 70.5% of cases, especially when surgeons expected a structural spinal disease (p = 0.009), when surgeons predicted MRI as “definitely beneficial” (p = 0.001), predominant radiculopathy (p = 0.008), absence of other joint pains (p = 0.000) and multiple comorbidities (p = 0.025). CONCLUSION: A comprehensive clinical assessment can effectively guide surgeons in ordering MRI scans with more than 70% usefulness in diagnosing diseases and planning treatment. Surgeons’ pre-MRI judgment based on symptoms, other joint pains, red flags significantly predicts MRI yield and clinical impact in lumbar spine disorders.