Should I Get an MRI or X-Ray for Back Pain? Dubai Spine Surgeon Dr. Sherief Elsayed Explains

Back pain is one of the most common reasons people visit doctors in Dubai and across the UAE. When pain strikes, many patients immediately wonder: “Do I need an MRI?” or “Should I get an X-ray?” It’s a natural question, especially when you’re struggling with discomfort that affects your daily life, work, or sleep.

But here’s something important to understand: imaging tests like MRI and X-rays are valuable tools, but they’re not always the first step. In fact, getting scans too early or without proper clinical assessment can sometimes lead to unnecessary worry, confusion, or even treatments you don’t actually need.

Dr. Sherief Elsayed, a senior UK-trained spinal surgeon practicing in Dubai, takes a different approach. With over 25 years in medicine and 20 years dedicated to spine and orthopaedic care, he emphasises one key principle: “Pain is a symptom, not a diagnosis.” This means understanding what’s causing your pain through a thorough clinical assessment comes before deciding which imaging test, if any, you actually need.

In this article, we’ll walk through everything you need to know about MRI and X-ray imaging for back pain, when each test is appropriate, and how Dr. Sherief Elsayed approaches spine diagnosis in his Dubai practice.

What’s the difference between an MRI and an X-ray for back pain?

Let’s start with the basics. MRI and X-ray are two completely different types of imaging, and each one shows different things.

X-rays use radiation to create images of hard structures in your body, mainly bones. When it comes to your spine, an X-ray can show:

• The alignment of your vertebrae
• Bone spurs or arthritis changes
• Fractures or breaks in the bone
• The spacing between vertebrae
• Signs of spinal instability or unusual curves

X-rays are quick, widely available, and relatively inexpensive. They’re excellent for looking at the bony structure of your spine, but they don’t show soft tissues like discs, nerves, or muscles very well.

MRI (Magnetic Resonance Imaging) uses powerful magnets and radio waves to create detailed images of both hard and soft tissues. An MRI of your spine can show:

• Intervertebral discs and whether they’re bulging, herniated, or degenerated
• Spinal nerves and whether they’re compressed or inflamed
• The spinal cord itself
• Muscles, ligaments, and other soft tissues
• Tumours, infections, or inflammatory conditions
• Blood flow and tissue health

MRI scans take longer to perform (usually 30 to 60 minutes), cost more, and provide much more detailed information about what’s happening inside your spine beyond just the bones.

Do I need imaging tests immediately when I have back pain?

This is where Dr. Sherief Elsayed’s approach differs from what many patients expect. Most people assume that back pain automatically means they need a scan. The reality is more nuanced.

Research shows that about 80 to 90 percent of acute back pain episodes improve within 4 to 6 weeks with conservative care, regardless of what shows up on an MRI or X-ray. In fact, many imaging findings that look concerning such as disc bulges, minor disc degeneration, or small bone spurs are incredibly common in people who have absolutely no pain at all.

Studies have found disc bulges in up to 30 to 40 percent of people in their 20s who have never experienced back pain, and that number increases with age. By age 60, the majority of people have some degree of disc degeneration visible on MRI, yet many feel perfectly fine.

This is why Dr. Sherief Elsayed emphasises: “We treat the person, not the scan.”

His approach begins with a comprehensive clinical assessment that includes:

• Detailed history: When did the pain start? What were you doing? What makes it better or worse? How does it affect your daily activities?
• Lifestyle and ergonomics review: Your work setup, sleeping position, exercise habits, and daily movement patterns
• Physical examination: Testing your range of motion, muscle strength, reflexes, and nerve function
• Functional assessment: How your spine moves and responds during actual activities

This thorough evaluation often reveals the underlying cause of your pain without needing imaging tests at all. Many cases of back pain are related to muscle strain, poor posture, ergonomic issues, or minor mechanical problems that respond well to physiotherapy, posture correction, activity modification, and sometimes anti-inflammatory medications.

When does Dr. Sherief Elsayed recommend getting an X-ray for back pain?

X-rays are typically the first imaging test ordered when scans are needed, and Dr. Sherief Elsayed might recommend an X-ray in these situations:

After trauma or injury: If you’ve had a fall, car accident, or significant injury, an X-ray can quickly rule out fractures or serious bone damage.

To assess spinal alignment: If your examination suggests problems with how your spine is aligned, such as scoliosis or other deformities, X-rays can measure the degree of curvature and track changes over time.

When bone conditions are suspected: Conditions like arthritis, bone spurs, or vertebral compression fractures show up clearly on X-rays.

Before considering certain treatments: Some injections or procedures require X-ray guidance or knowledge of your spinal anatomy beforehand.

To check stability: Dynamic X-rays (taken while you bend forward and backward) can show if vertebrae are moving too much, suggesting instability.

The key point is that X-rays are ordered when the clinical assessment suggests a bone-related problem or structural issue that would benefit from visualisation. They’re not routinely ordered for every patient with back pain.

When is an MRI scan necessary for back pain in Dubai?

MRI scans provide much more detailed information, but they’re also more expensive and time-consuming. Dr. Sherief Elsayed typically recommends an MRI when:

Red flag symptoms are present: These are warning signs that suggest something serious might be happening, such as:

• Progressive weakness in your legs
• Loss of bladder or bowel control
• Numbness in your inner thighs or groin area (saddle anaesthesia)
• Unexplained weight loss
• Fever along with back pain
• History of cancer
• Severe pain that’s getting worse despite treatment

Nerve-related symptoms persist: If you have leg pain, numbness, tingling, or weakness that travels down from your back (sciatica or radiculopathy) and these symptoms persist beyond 4 to 6 weeks of conservative treatment, an MRI can show whether a herniated disc or other structure is compressing a nerve.

Conservative treatment hasn’t worked: If you’ve tried appropriate conservative care for 6 to 12 weeks with little improvement, an MRI can help identify specific problems that might benefit from targeted interventions like injections or, rarely, surgery.

Surgery is being considered: Before any surgical procedure, an MRI is essential to clearly identify the problem, plan the approach, and ensure surgery is addressing the right issue.

Unusual presentations: If your symptoms don’t fit typical mechanical back pain patterns, an MRI can help rule out serious conditions like infections, tumours, or inflammatory diseases.

What happens during Dr. Sherief Elsayed’s assessment before deciding on imaging?

Understanding Dr. Sherief Elsayed’s diagnostic process helps explain why imaging isn’t always the first step.

When you visit his clinic in Dubai, the assessment focuses on finding the root cause of your pain, not just treating symptoms. Here’s what typically happens:

Step 1: Comprehensive History

Dr. Sherief Elsayed takes time to understand your pain story. He’ll ask about:

• The exact nature of your pain (sharp, dull, burning, aching)
• What movements or positions make it better or worse
• Whether pain travels down your legs or stays in your back
• How it affects your sleep, work, and daily activities
• Your medical history, including any previous spine problems
• Your lifestyle, work environment, and activity level

Step 2: Physical Examination

This is where clinical expertise really matters. The examination includes:

• Observing how you move and your posture
• Testing your spine’s range of motion
• Checking muscle strength in specific muscle groups
• Testing reflexes in your knees and ankles
• Assessing sensation in different areas
• Special tests that can indicate nerve compression or specific problems
• Examining how your spine responds to pressure and movement

Step 3: Correlation and Discussion

Dr. Sherief Elsayed then correlates your history with examination findings to form a clinical picture. He explains his findings in simple terms and discusses:

• What’s likely causing your pain
• Whether imaging would provide useful additional information
• What treatment options make sense as a first step
• What warning signs to watch for
• When to follow up

This approach follows the principle: “Every spine is different. Every treatment should be, too.”

What if my MRI or X-ray shows something abnormal?

This is where Dr. Sherief Elsayed’s philosophy of treating the person, not the scan, becomes especially important.

Many people get worried when their imaging report mentions things like:

• Disc bulges or protrusions
• Mild to moderate disc degeneration
• Facet joint arthritis
• Small bone spurs
• Minor disc desiccation (drying out)

Here’s the reassuring truth: these findings are incredibly common in people without any pain. A disc bulge on MRI doesn’t automatically mean you need surgery or that your spine is seriously damaged. In fact, many disc bulges shrink or reabsorb naturally over time.

What matters most is whether the imaging findings match your symptoms. Dr. Sherief Elsayed carefully correlates what the scan shows with:

• Where you feel pain
• Which movements trigger symptoms
• What the physical examination revealed
• How your symptoms have progressed

Sometimes an MRI shows a disc herniation, but the clinical examination doesn’t support that being the pain source. In these cases, treating the actual cause (which might be muscular or postural) leads to better outcomes than focusing on the scan finding.

Conversely, when imaging findings match your clinical presentation perfectly, it helps confirm the diagnosis and guide treatment with more precision.

How does imaging guide treatment decisions in Dubai spine care?

Once appropriate imaging is obtained, Dr. Sherief Elsayed uses it as part of a comprehensive treatment strategy, not as the sole decision-maker.

His treatment approach follows a stepped pathway:

Step 1: Conservative Care Even with imaging findings, most patients benefit from starting with:

• Targeted physiotherapy and exercise programmes
• Posture and ergonomic corrections
• Activity modification and movement education
• Anti-inflammatory medications when appropriate
• Manual therapy techniques

Step 2: Minimally Invasive Interventions If conservative care doesn’t provide adequate relief and imaging supports it, options include:

• Targeted epidural or nerve root injections
• Facet joint injections or radiofrequency ablation
• Minimally invasive procedures like microdiscectomy or endoscopic discectomy

Step 3: Advanced Surgical Solutions Surgery is considered when:

• Conservative and minimally invasive treatments haven’t worked
• There are progressive neurological symptoms
• Imaging clearly shows a structural problem that matches symptoms
• Quality of life is significantly affected

Dr. Sherief Elsayed specialises in modern surgical techniques when needed, including:

• Robot-assisted spine surgery for enhanced precision
• Minimally invasive approaches that reduce recovery time
• Procedures like ACDF for neck problems or TLIF for lower back issues
• Disc replacement instead of fusion in selected cases

The key principle: “Surgery is not the first step. It is the right step only when necessary.”

What are the costs of MRI and X-ray scans in Dubai?

Cost is a practical consideration for many patients in the UAE. While prices vary between facilities, here’s a general guide:

X-rays typically cost between 200 to 500 AED depending on how many views are needed and the facility.

MRI scans are significantly more expensive, usually ranging from 1,500 to 3,500 AED or more, depending on which part of your spine is scanned and whether contrast is used.

Many health insurance plans in Dubai cover imaging when it’s medically necessary and ordered by a specialist. However, insurance typically won’t cover scans that aren’t clinically indicated, which is another reason why proper clinical assessment comes first.

Getting imaging without a proper assessment can also be a false economy. You might spend money on a scan that doesn’t change your treatment, or worse, shows incidental findings that lead to unnecessary worry or additional tests.

Can I just request an MRI without seeing a spine specialist first?

Technically, some imaging centres in Dubai will perform scans if you’re willing to pay out of pocket. However, this approach has several drawbacks:

You might get the wrong test: Without clinical assessment, you won’t know if an MRI, X-ray, or perhaps CT scan is most appropriate for your situation.

Results need expert interpretation: Getting an MRI report without a spine specialist to explain what it means in the context of your symptoms can cause confusion or unnecessary anxiety.

You might miss red flags: Some warning signs need urgent assessment, not just imaging. A clinical evaluation can identify these.

It may delay proper treatment: Starting with imaging instead of clinical assessment can actually slow down your path to feeling better.

Insurance won’t cover it: Most insurance requires imaging to be ordered by a physician for a medical reason.

Dr. Sherief Elsayed’s approach ensures that any imaging you get is:

• Clinically appropriate for your situation
• Likely to provide information that changes your management
• Properly interpreted in the context of your symptoms
• Part of a comprehensive treatment plan

What about repeat imaging if my pain comes back?

This is a common question. If you’ve had back pain before and undergone imaging, do you need new scans if the pain returns?

Not necessarily. Dr. Sherief Elsayed will consider:

• How long ago the previous imaging was done
• Whether your current symptoms are similar to before
• Whether anything has changed in your condition
• What the physical examination now shows

If your symptoms are similar and relatively recent imaging was normal or showed only minor age-related changes, repeat scans often aren’t needed. The focus stays on treating your current symptoms.

However, if:

• Your previous imaging was years ago
• Your symptoms are different or more severe
• You’ve developed new neurological symptoms
• There’s been new trauma
• Previous treatments that worked before aren’t helping now

Then new imaging might be warranted to see if anything has changed.

Expert insights: Dr. Sherief Elsayed’s approach to spine diagnosis in Dubai

What sets Dr. Sherief Elsayed apart in Dubai’s spine care landscape is his balanced, evidence-based approach that combines UK training standards with personalised patient care.

Having completed his fellowship at the Centre for Spinal Studies & Surgery at Queen’s Medical Centre in Nottingham and served as Lead Clinician for Spinal Surgery at Brighton & Sussex University Hospitals in the UK, he brings rigorous clinical standards to his Dubai practice.

His diagnostic philosophy rests on several key principles:

Clinical assessment is paramount: Technology is a tool, but it doesn’t replace skilled clinical evaluation. A thorough history and physical examination often reveal the cause of back pain and guide whether imaging is needed.

Correlation is critical: An MRI finding only matters if it matches your symptoms. Many abnormalities seen on scans are incidental and unrelated to your pain.

Conservative care first: Unless red flags are present, starting with non-surgical treatment makes sense for most back pain. This includes physiotherapy, lifestyle modifications, and sometimes medications or injections.

Shared decision-making: Dr. Sherief Elsayed believes in explaining options clearly so patients understand their choices and participate actively in decisions about their care.

Expertise in both approaches: While he’s skilled in advanced surgical techniques including robot-assisted surgery, his philosophy is that surgery should be “the right step only when necessary.”

For UAE patients, this means you get world-class spine expertise without unnecessary interventions. Whether your back pain needs simple reassurance and physiotherapy, targeted injections, or eventually surgery, the pathway is guided by what your specific situation requires, not by one-size-fits-all protocols.

Real patient scenarios: When imaging changed the plan

To make this concrete, here are scenarios that illustrate when imaging was and wasn’t necessary:

Scenario 1: Office worker with acute back pain

A 35-year-old patient working in Dubai Marina developed lower back pain after moving furniture. The pain was localised to the lower back with no leg symptoms. Physical examination showed muscle spasm but no neurological signs.

Dr. Sherief Elsayed’s assessment: Likely muscular strain. Treatment started with physiotherapy and postural advice. No imaging was needed. The patient improved within 3 weeks.

Scenario 2: Persistent leg pain after conservative care

A 52-year-old patient had lower back and left leg pain for 8 weeks. Despite physiotherapy and medications, the leg pain persisted. Physical examination showed reduced ankle reflex and positive nerve tension signs.

Dr. Sherief Elsayed’s assessment: Clinical signs suggested nerve root compression. MRI was ordered, which confirmed a disc herniation at L5-S1 matching the symptoms. This guided a targeted nerve root injection that provided significant relief.

Scenario 3: Back pain with red flag symptoms

A 67-year-old patient developed back pain with progressive leg weakness over 2 weeks, plus difficulty controlling bladder function.

Dr. Sherief Elsayed’s assessment: Red flags present suggesting possible cauda equina syndrome. Urgent MRI was arranged immediately, which showed severe spinal stenosis. Emergency decompression surgery was performed.

These examples show how clinical judgment determines when imaging is necessary and when it’s not.

Conclusion

If you’re experiencing back pain in Dubai, your first question shouldn’t be “Where can I get an MRI?” but rather “What’s actually causing my pain, and what do I need to know to address it properly?”

Dr. Sherief Elsayed’s approach prioritises understanding your unique situation through comprehensive clinical assessment. Imaging tests like X-rays and MRI scans are valuable tools, but they’re most useful when ordered for the right reasons at the right time.

Remember these key points:

• Most back pain improves with conservative care, regardless of imaging findings
• Clinical assessment comes before imaging decisions
• Not all scan abnormalities cause pain or need treatment
• Red flag symptoms always warrant prompt evaluation and imaging
• The best treatment plan treats you as a person, not just a scan report

If you’re struggling with back pain and wondering whether you need imaging, the best first step is a thorough assessment by a spine specialist who can guide you toward the right diagnostic pathway and treatment plan for your specific situation.