Red flags include suspected epidural abscess or hematoma presenting with acute pain, but no neurological symptoms (urgent imaging is required); suspected cancer; suspected infection; cauda equina syndrome; severe or progressive neurologic deficit; and suspected compression fracture. In patients with suspected uncomplicated herniated disc or spinal stenosis, imaging is only indicated after at least a six-week trial of conservative management and if symptoms are severe enough that surgery is being considered.
Sources:
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American College of Radiology. ACR appropriateness criteria® low back pain [Internet]. 2015 [cited 2017 May 5].
Bach SM, et al. Guideline update: What’s the best approach to acute low back pain? J Fam Pract. 2009 Dec;58(12):E1. PMID: 19961812. https://www.ncbi.nlm.nih.gov/pubmed/19961812
Chou R, et al. Imaging strategies for low-back pain: Systematic review and meta-analysis. Lancet. 2009 Feb 7;373(9662):463-72. PMID: 19200918.
Chou R, et al. Diagnostic imaging for low back pain: Advice for high-value health care from the American College of Physicians. Ann Intern Med. 2011 Feb 1;154(3):181-9. PMID: 21282698.
Goertz M, et al. Adult acute and subacute low back pain [Internet]. 2012 Nov [cited 2017 May 5].
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National Collaborating Centre for Primary Care (UK). Low back pain: Early management of persistent non-specific low back pain. 2009 May. PMID: 20704057.
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van Rijn RM, et al. Computed tomography for the diagnosis of lumbar spinal pathology in adult patients with low back pain or sciatica: A diagnostic systematic review. Eur Spine J. 2012 Feb;21(2):228-39. PMID: 21915747.
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Related Resources:
Patient Pamphlet: Imaging Tests for Lower Back Pain: When you need them and when you don’t