Health authorities and researchers recommend avoiding unnecessary X-rays for non-specific back pain because:
- X-rays often reveal age-related changes that do not necessarily cause pain.
- Overdiagnosis can lead to unnecessary concern for patients.
- Inappropriate use of X-rays increases costs and exposes patients to unnecessary radiation.
- Random findings may lead to additional unnecessary treatment.
Nevertheless, some chiropractors use spinal X-rays to assess patients and plan treatments of the patients, according to a new study. It is unclear whether the findings on X-rays have any real significance in determining whether patients experience improvements in pain and function. This is particularly important for older adults with chronic back pain, as understanding whether X-rays can predict treatment outcomes is crucial.
While there are certain situations where X-rays are necessary (e.g., suspected serious conditions such as fractures or tumours), they do not appear to be useful in predicting the outcomes of standard chiropractic treatment.
The researchers conclude that chiropractic treatment and home exercises may have beneficial effects for older adults with chronic back pain, but X-rays are not necessary to predict who will benefit from treatment. In the absence of signs of serious illness, treatment should proceed without X-rays, which can help save resources and reduce unnecessary radiation exposure.
The study was a secondary analysis of data from a previous clinical trial involving older adults (65+) with chronic back pain. A total of 120 participants were included, all of whom had baseline X-rays of the lumbar spine. Two chiropractic radiologists evaluated the images for anatomical and degenerative changes, such as disc degeneration, anterolisthesis and retrolisthesis, scoliosis, or other structural abnormalities.
After 12 weeks of treatment, participants' improvements were assessed using the Oswestry Disability Index (ODI), where a reduction of at least 30% was considered a significant improvement. The researchers then compared the X-ray findings with the participants who experienced improvements.
- 5% of participants experienced a clinically significant improvement in their back pain and function.
- Common findings on X-rays included moderate to severe disc degeneration (66.6% of participants), anterolisthesis (53.3%), and scoliosis (35%).
- There was no statistically significant association between any of the analyzed X-ray findings and whether a person experienced improvement after treatment.
- Even among individuals with more severe degenerative changes, there was no clear correlation with their treatment outcomes.
The results suggest that routine spinal X-rays are unlikely to help predict who will benefit from chiropractic treatment and home exercises. This challenges the practice of using X-rays to guide chiropractic treatment decisions.
Michele J. Maiers, Andrea K. Albertson, Christopher Major, Heidi Mendenhall and Christopher P. Petrie. The association between individual radiographic findings and improvement after chiropractic spinal manipulation and home exercise among older adults with back-related disability: a secondary analysis. Chiropractic & Manual Therapies 2024.