Street KJ, et al. - In this retrospective, observational cohort study of individuals (n = 2,383) referred for lumbar MRI by a specialist in private secondary care or public tertiary care setting over a 10-month period, ascertain the predominance of severe pathologies in individuals with low back pain and to examine prevalence of these severe pathologies in the geographic region of South Auckland, New Zealand. For all pathologies examined in this study, the prevalence was considerably higher in the public tertiary care setting vs private secondary care setting. Moreover, structural abnormalities related to severe pathology were exhibited by one in every 6.5 individuals referred for MRI in tertiary care, which proposes the question of if access to MRI should be re-assessed.