Yield of spinal x-rays among adults less than 50 years of age is low with only one study in 2500 plain lumbar spine x-rays revealing something not expected on clinical grounds (Nachemson).
Associated with a high frequency of irrelevant findings with MRI studies, revealing that adults younger than 60 years and no history of back pain or sciatica commonly have bulging discs and degenerative discs and almost 25% have herniated discs (Bolden).
MRI testing in asymptomatic older adults the findings of bulging and degenerative discs is even higher, to the point of being ubiquitous (Bolden).
The use of plain x-rays and CT scans show high degree of anatomic abnormalities in asymptomatic patients.
In patients with no indication of underlying systemic disease or major neurological complications spinal imaging does not improve patient outcomes.
In a study of 1804 patient no advantages were noted from imaging with regard to pain and function in the short or long-term (Chou).
In a study of 246 patients with acute back pain or sciatica randomized to MRI or clinical evaluation only, both groups improved over the subsequent year with similar clinical outcomes.
Patients blinded to MRI results have better clinical outcomes than for those who know the results of the testing (Ash).
421 British patients with at least six weeks of back pain and randomized to receive plain films, or not, reported more pain and lower health status at 3 month follow-up and were more likely to see their physician in follow-up if they received radiological imaging (Kendrick).
In the Kendrick study patients who received radiographic studies reported to be more satisfied with their care, despite worse outcomes.
In a randomized trial comparing MRI with plain radiographs as the first testing for patients with back pain the groups had similar health outcomes but the group receiving MRIs was more than twice as likely to undergo surgery in the subsequent year (Jarvik).