Acute low back pain is a common health problem affecting between 50-90% of people over the course of a lifetime with less than 2% of cases representing potentially serious conditions requiring surgical or medical intervention. Red flags suggesting additional testing include such things as a history of significant trauma, cauda equina syndrome, symptoms suggestive of tumour or infection (fever, weight loss, history of cancer), steroid use, etc. However, the majority of acute low back pain episodes are benign, self-limited cases that do not warrant any imaging studies. Unnecessary imaging can be harmful due to the potential adverse health effects associated with radiation exposure and due to attribution of symptoms to unrelated incidental findings leading to prolonged disability.
Sources:
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.
Davis PC, et al. ACR Appropriateness Criteria® low back pain [Internet]. Reston (VA): American College of Radiology (ACR); 2011 [cited 2014 Sep 19].
Henschke N, et al. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum. Oct 2009;60(10):3072-3080. PMID: 19790051.
Linet MS, et al. Cancer risks associated with external radiation from diagnostic imaging procedures. CA Cancer J Clin. 2012 Mar-Apr;62(2):75-100. PMID: 22307864.
Talmage J, et al. Low back disorders. In: Hegmann K, ed. Occupational Medicine Practice Guidelines 3rd Edition. Elk Grove Village (IL): American College of Occupational and Environmental Medicine; 2011.
Toward Optimized Practice. Guideline for the evidence-informed primary care management of low back pain 2nd Edition [Internet]. Edmonton (AB): Toward Optimized Practice Program; 2011 [cited 2014 Sep 23].
Related Resources:
Patient Pamphlet: Imaging Tests for Lower Back Pain: When you need them and when you don’t