MRI Lumbar Spine — Low Back Pain [OUTPATIENT]
MRINICE NG592016, updated 2020v2.0 · March 2026
Varies
Outpatient
Required Assessment Tools
OPTIONAL
STarT Back
Risk assessment tool for low back pain — use at first point of contact (NG59 Rec 1.1.2)
Stratifies into low, medium, high risk
Routine imaging NOT recommended
Routine imaging NOT recommended
- Do not routinely offer imaging in a non-specialist setting for people with low back pain with or without sciaticaNICE NG59 Rec 1.1.4
- Consider imaging in specialist settings only if result likely to change managementNICE NG59 Rec 1.1.6
When MRI IS justified
— ANY of the following
- Suspected cauda equina syndrome — see CES protocol
- Pre-surgical planning for radiculopathy after ≥6 weeks failed conservative management with progressive neurological deficit
- Suspected spinal malignancy, infection, or inflammatory disease (red flags)
- Red flags: new onset bladder/bowel disturbance; saddle sensory disturbance; bilateral leg weakness; age >50 with new back pain; history of cancer; unexplained weight loss; thoracic pain; fever
Notes
Warning
Do NOT routinely image low back pain — most does not change management (NG59)
NICE NG59Information
STarT Back risk assessment tool recommended at first contact
Information
Red flags warrant urgent investigation
Modality Preference
MRI preferred. No ionising radiation; superior soft tissue contrast for disc, cord, and root assessment
Source: NICE NG59; RCR iRefer
Change Log
v2.02026-03-08New protocol — MRI lumbar spine with emphasis on appropriate use