A Neuroradiology Pathway
GPs in Lothian have open access for Lumbar Spine imaging. In recent years, the use of this pathway has significantly and appropriately decreased due to the establishment of the NHS Lothian Integrated Back Pain Pathway.
In most cases from Primary Care it may be more suitable to refer patients to NHS Lothian Integrated Back Pain Pathway as outlined on the Lumbar Spine RefHelp page. When referring to the Integrated Back Pain service an MRI is not required at point of referral. If an MRI is indicated as part of a patient’s management this will be requested within the multidisciplinary service at the appropriate time for the patient and any intervention that may be required. A patient leaflet to support this decision has been created in conjunction with Neurosurgery, Neurology, Radiology, GPs and Physiotherapy in NHS Lothian. A link to this leaflet is available below.
It is vital that in the case of Serious lumbar spine conditionsthat GPs do not delay Clinical review by arranging imaging. Please see the Serious lumbar spine conditions RefHelp page for how to seek clinical review, rather than arranging MRI, when there are clinical concerns about serious lumbar pathology including suspected cauda equina syndrome, acute foot drop, deteriorating lumbar radiculopathy, suspected metastatic spinal cord compression.
In many cases neuroradiological investigation complements neurosurgical or neurological opinion and should not replace clinical referral. If there is uncertainty as to whether and what imaging is appropriate, and how urgently this should be performed, the Duty Consultant Neuroradiologist can be contacted via the Department of Neuroradiology, DCN (RIE)
Low-Back-Pain-and-MRI-scans.pdf
SG & JB 8/1/26
Who to refer
Lumbar imaging for isolated low-back pain does not improve clinical outcomes. MRI should only be considered in patients with low back pain in the presence of at least one of the following:
- Failure to respond to conservative management
- Progression of symptoms
- 6 weeks history of radiculopathy refractory to conservative management
- Planning surgical intervention or specialist chronic pain management.
And only when the patient does not have signs of Serious lumbar spine pathologyand only when the patient is not suitable for referral via the NHS Lothian Integrated Back Pain Pathway
How to refer:
Using SCI Gateway:
- SJH> Clinical Radiology > LI SJH Neuroradiology
- WGH> Neuroradiology > LI Neuroradiology – Select MRI Lumbar Spine from Dropdown menu
Please note that for this pathway (Lumbar Spine MRI) Edinburgh, East and Mid Referrals DCN is now based at the RIE, however the referrals should still be sent to the WGH until the pathway has been updated on SCI Gateway. When this changes this webpage will be updated and all GPs will be informed by email.
