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MRI Has Limited Impact on Epidural Steroid Decisions

Marginally influences docs' decision making; does not improve lumbosacral radiculopathy outcomes

WEDNESDAY, Dec. 14 (HealthDay News) -- For patients with lumbosacral radiculopathy who are clinical candidates for epidural steroid injections (ESI), magnetic resonance imaging (MRI) does not improve treatment outcomes, and only marginally influences physicians' decision making, according to a study published online Dec. 12 in the Archives of Internal Medicine.

Steven P. Cohen, M.D., from the Johns Hopkins School of Medicine in Baltimore, and colleagues investigated whether MRI improves outcomes or influences decision making for patients with lumbosacral radiculopathy who are referred for ESI. The treating physician for patients in group 1 was blinded to patients' MRI results, while the physician for group 2 patients reviewed the MRIs before deciding on treatment. An independent physician reviewed group 1 patients' MRIs and proposed a treatment plan, which was compared with the treatment they received.

The investigators found that group 2 patients had slightly lower leg pain scores at one month than group 1 (mean scores, 3.6 versus 4.4; P = 0.12), but pain scores and function at three months did not differ between the groups. At all time points, a similar proportion of patients experienced a positive outcome. Group 1 patients who received a different injection than that proposed by the independent physician had significantly inferior scores for both leg pain and function than patients whose injection correlated with imaging. After the MRI was reviewed, a total of 6.8 percent of the patients did not (group 2) or would not (group 1) have received an ESI.

"Although MRI may have a minor affect on decision making, it is unlikely to avert a procedure, diminish complications, or improve outcomes," the authors write.

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