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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

MRI of disk bulge at L5-S1
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Fig4: MRI of disk bulge at L5-S1

Mentions: Routine advanced imaging is also not associated with improved patient outcomes. Many radiographic abnormalities are detected with MRI and CT that are poorly related with the symptoms and sometimes such incidental findings leads to unnecessary additional workup or intervention. MRI studies identified 22–40% of adults with herniated disk, who are asymptomatic and pain free, but one study found 81% of such asymptomatic individuals with a bulging disk (Fig. 4) [1]. Thus, a MRI should not be ordered to evaluate for the presence of a herniated disk as an initial step in the diagnosis as it is more commonly an incidental finding and may not be the cause of pain. An initial conservative approach is more cost-effective and medically appropriate in acute low back pain for the first 4–6 weeks. The MRI becomes more valuable for evaluating patients with persistent radicular symptoms despite conservative treatment.Fig. 4


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

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

MRI of disk bulge at L5-S1
© Copyright Policy
Related In: Results  -  Collection

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

Fig4: MRI of disk bulge at L5-S1
Mentions: Routine advanced imaging is also not associated with improved patient outcomes. Many radiographic abnormalities are detected with MRI and CT that are poorly related with the symptoms and sometimes such incidental findings leads to unnecessary additional workup or intervention. MRI studies identified 22–40% of adults with herniated disk, who are asymptomatic and pain free, but one study found 81% of such asymptomatic individuals with a bulging disk (Fig. 4) [1]. Thus, a MRI should not be ordered to evaluate for the presence of a herniated disk as an initial step in the diagnosis as it is more commonly an incidental finding and may not be the cause of pain. An initial conservative approach is more cost-effective and medically appropriate in acute low back pain for the first 4–6 weeks. The MRI becomes more valuable for evaluating patients with persistent radicular symptoms despite conservative treatment.Fig. 4

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