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What is the role of imaging in acute low back pain?

Lateef H, Patel D - Curr Rev Musculoskelet Med (2009)

Bottom Line: In patients with non specific acute low back pain, without the red flags, a conservative approach is preferable, with assessment in 4-6 weeks.However, a plain radiograph or more advanced imaging techniques like MRI/CT may be ordered in back pain associated with radiculopathy or spinal stenosis and back pain associated with progressive neurologic deficits.There is limited role of imaging in non specific acute low back pain without the red flags, as the findings correlate poorly with symptoms.

View Article: PubMed Central - PubMed

Affiliation: Flower Hospital Family Medicine Residency, Sylvania, OH, USA.

ABSTRACT
In patients with non specific acute low back pain, without the red flags, a conservative approach is preferable, with assessment in 4-6 weeks. The natural history of low back pain is favorable with improvement over time, thus reassurance to such patients is very important. However, a plain radiograph or more advanced imaging techniques like MRI/CT may be ordered in back pain associated with radiculopathy or spinal stenosis and back pain associated with progressive neurologic deficits. There is limited role of imaging in non specific acute low back pain without the red flags, as the findings correlate poorly with symptoms.

No MeSH data available.


Related in: MedlinePlus

Right oblique image of L5 Spondylolysis
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Fig2: Right oblique image of L5 Spondylolysis

Mentions: In most cases, anteroposterior (AP) and lateral views are the first line of approach, as higher radiation exposure is associated with oblique films. Plain AP and lateral radiographs are also the initial imaging study obtained for a suspected compression fracture [8]. The compression fractures tend to occur at multiple levels, so it is important to radiograph the entire spine. Oblique films are ordered when there is suspicion of spondylolysis, as suggestive from history and physical examination. Oblique views show the pars interarticularis in profile and thus helps in the diagnosis of spondylolysis [1]. In these images the defect in the pars may become evident by looking for the fracture of the neck of the “Scottie dog” (Figs. 1, 2). In patients with possible spondylolisthesis or prior spinal surgery, flexion, or extension films should be obtained (Fig. 3) [13].Fig. 1


What is the role of imaging in acute low back pain?

Lateef H, Patel D - Curr Rev Musculoskelet Med (2009)

Right oblique image of L5 Spondylolysis
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2697333&req=5

Fig2: Right oblique image of L5 Spondylolysis
Mentions: In most cases, anteroposterior (AP) and lateral views are the first line of approach, as higher radiation exposure is associated with oblique films. Plain AP and lateral radiographs are also the initial imaging study obtained for a suspected compression fracture [8]. The compression fractures tend to occur at multiple levels, so it is important to radiograph the entire spine. Oblique films are ordered when there is suspicion of spondylolysis, as suggestive from history and physical examination. Oblique views show the pars interarticularis in profile and thus helps in the diagnosis of spondylolysis [1]. In these images the defect in the pars may become evident by looking for the fracture of the neck of the “Scottie dog” (Figs. 1, 2). In patients with possible spondylolisthesis or prior spinal surgery, flexion, or extension films should be obtained (Fig. 3) [13].Fig. 1

Bottom Line: In patients with non specific acute low back pain, without the red flags, a conservative approach is preferable, with assessment in 4-6 weeks.However, a plain radiograph or more advanced imaging techniques like MRI/CT may be ordered in back pain associated with radiculopathy or spinal stenosis and back pain associated with progressive neurologic deficits.There is limited role of imaging in non specific acute low back pain without the red flags, as the findings correlate poorly with symptoms.

View Article: PubMed Central - PubMed

Affiliation: Flower Hospital Family Medicine Residency, Sylvania, OH, USA.

ABSTRACT
In patients with non specific acute low back pain, without the red flags, a conservative approach is preferable, with assessment in 4-6 weeks. The natural history of low back pain is favorable with improvement over time, thus reassurance to such patients is very important. However, a plain radiograph or more advanced imaging techniques like MRI/CT may be ordered in back pain associated with radiculopathy or spinal stenosis and back pain associated with progressive neurologic deficits. There is limited role of imaging in non specific acute low back pain without the red flags, as the findings correlate poorly with symptoms.

No MeSH data available.


Related in: MedlinePlus