MRI scans in neck pain - is there anything to see?

28 Jun 2019

Magnetic resonance imaging (MRI) is a type of scan often undertaken to investigate disease and injury, including for people with neck pain following a whiplash injury. However, many of the findings on MRI thought to explain a patient’s neck pain, like a bulging disc or joint degeneration, are commonly seen in people without any symptoms. This raises questions about the clinical significance of findings on MRI scans for people with neck pain.

A systematic review was published in the Journal of Magnetic Resonance Imaging this month authored by RECOVER researchers Dr Scott Farrell, Professor Michele Sterling and Dr Ashley Smith, with colleagues from Australian National University and Macquarie University. This study sought to investigate the significance of MRI findings in neck pain, by gathering and synthesising all of the published research data to determine if there are differences on MRI scans between people with neck pain (including whiplash) and people with no pain.

After screening nearly 8,000 studies, 31 scientific papers were identified which compared MRI findings between individuals with and without neck pain in about 4,000 people. Results indicated that for many types of MRI findings, such as disc degeneration and ligament changes, no differences existed between people with neck pain and controls. For some other MRI findings such as muscle size and muscle fat content, there were differences between neck pain patients and pain-free people. However, these were often observed in single studies (and so haven’t been replicated or verified), in small studies, or conflicted with findings of other studies.

The review indicates that due to the inconsistent findings of the research to date, as well as the low quality of many of the included studies, we still do not conclusively know whether there are differences on MRI between people with neck pain (including whiplash) and pain-free people, and so the clinical significance of MRI scans in these patients remains unclear.

Reference: Farrell SF, Smith AD, Hancock MJ, Webb AL & Sterling M. (2019). Cervical spine findings on MRI in people with neck pain compared with pain‐free controls: A systematic review and meta‐analysis. J Magn Reson Imaging, 49: 1638-1654. doi:10.1002/jmri.26567