What imaging studies are recommended for diagnosing radiculopathy in primary care, and when should I consider referring for MRI?

Imaging studies recommended for diagnosing radiculopathy in primary care: Initial imaging is generally not required in primary care for radiculopathy unless there are red flag symptoms or signs suggesting serious underlying pathology such as spinal metastases, spinal cord compression, or spinal injury. Plain X-rays are not recommended to diagnose radiculopathy or spinal metastases in adults. If imaging is needed, referral for MRI is the preferred modality to assess nerve root or spinal cord involvement.

When to consider referring for MRI: Refer the patient for magnetic resonance imaging (MRI) if there is clinical suspicion of serious pathology such as spinal metastases, spinal cord compression, or if neurological abnormalities are present that could be attributable to spinal cord or nerve root injury. MRI should be performed urgently (within 24 hours) if metastatic spinal cord compression is suspected, or within 1 week if spinal metastases are suspected without cord compression. MRI is also indicated if neurological signs or symptoms persist or worsen despite conservative management, or if surgical intervention is being considered for radiculopathy or sciatica with consistent radiological findings.

Additional notes: If MRI is contraindicated, CT scanning may be used as an alternative. Plain X-rays may be considered in children under 16 if MRI is not indicated but clinical suspicion remains. CT is preferred over X-ray in adults with suspected spinal injury and neurological signs. Routine imaging is not recommended for uncomplicated low back pain or radiculopathy without red flags.

References: ¹,²,³