Don’t routinely image patients with low back pain regardless of the duration of symptoms unless: – there are clinical reasons to suspect serious underlying pathology (i.e., red flags) – imaging is necessary for the planning and/or execution of a particular evidenced-based therapeutic intervention on a specific spinal condition.

Unless the image has a direct bearing on the treatment decision it is not required. Spinal “abnormalities” in asymptomatic individuals are common and increase with age. For those with back dominant symptoms (i.e., axial back pain) there is an extremely high false positive rate; most of the findings have no correlation with the clinical picture. For the majority of low back complaints obtaining spinal imaging does not improve patient care but can lead to inappropriate interventions and does have a detrimental impact on patient outcomes. Red flags include cauda equina syndrome; severe or progressive neurologic deficits; suspected cancer; suspected infection: suspected fracture and suspected epidural abscess or hematoma.

 

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.

 

Related Resources:

Patient Pamphlet: Imaging Tests for Lower Back Pain: When you need them and when you don’t

Patient Pamphlet: Treating Lower Back Pain: How much bed rest is too much?