Search for other papers by Marjorie Eskay Auerbach in
Current site
Google Scholar
PubMed
Abstract
Although back pain is the most common and expensive cause of work disability in the United States, our understanding of low back pain (LBP) is limited despite the advantages of advanced imaging technologies. Diagnostic studies often are requested for fear of missing serious or occult pathology or to reassure patients but have a low likelihood of identifying a specific cause for the reported symptoms in patients who present with nonspecific LBP. From a clinical perspective, the information provided in lumbar imaging, whether plain X rays or magnetic resonance imaging (MRI), has not been found either to influence treatment recommendations or improve outcomes. Further, routine advanced imaging is not associated with improved outcomes and identifies many radiographic findings that correlate poorly with symptoms; imaging is recommended when severe or progressive neurologic deficit is present or if serious underlying disease is suspected. Surgery rates are highest where imaging rates are highest, and a significant proportion of the variation in rates of spine surgery can be explained by differences in the rates of advanced spinal imaging. Because imaging has no role in the impairment rating of nonspecific LBP, an individual's having a work injury that requires an impairment rating is not a reason to order spinal imaging. To answer the question in this article's title, the answer usually is not to order a spinal image.
-
1.
Jarvik JG, Deyo R. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med. 2002;137:586–97.
-
2.
Deyo R, Mirza S, Turner Y. Overtreating chronic back pain: time to back off? J Am Board Fam Med. 2009;22(1):62–8.
-
3.
Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, Sullivan SD. Expenditures and health status among adults with back and neck problems. JAMA 2008; 299: 656–64.
-
4.
Deyo R, Mirza S, Turner Y. Overtreating chronic back pain: time to back off? J Am Board Fam Med 2009;22(1):62–8.
-
5.
Wassenar M, van Rign R, van Tulder MW, et al. Magnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review. Eur Spine J 2012; 21:220–227.
-
6.
Jarvik JG, Deyo R. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med. 2002;137:586–97.
-
7.
Carragee E, Alamin T, Cheng I, et al. Are first-time episodes of serious LBP associated with new MRI findings? Spine J. 2006;6:624–35.
-
8.
Modic MT, Obuchowski NA, Ross JS, et al. Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiology. 2005;237(2):597–604.
-
9.
Chou R, Fu R, Carrino J, et al. Imaging strategies for low-back pain: systematic review and metanalysis. Lancet. 2009;373:463–72.
-
10.
Chou R, Qaseem A, Snow B, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478–91.
-
11.
Wassenar M, van Rign R, van Tulder MW, et al. Magnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review. Eur Spine J. 2012; 21:220–227.
-
12.
Chou R, Deyo RA, Jarvik JG. Appropriate Use of Lumbar Imaging for Evaluation of Low Bck Pain. Radiol Clin N Am. 2012;50:569–585.
-
13.
Chou R, Qaseem A, Snow B, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478–91.
-
14.
Maus T. Imaging the Back Pain Patient. Phys Med Rehabil Clin N Am. 2010;21:725–766.
-
15.
Ash LM, Modic MT, et al. Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain. AJNR 2008;Jun;29(6):1098–103.
-
16.
Maus T. Imaging the Back Pain Patient. Phys Med Rehabil Clin N Am. 2010;21:725–766.
-
17.
Graves J, Fulton-Kehoe D, et al. Factors Associated With Early Magnetic Resonance Imaging Utilization for Acute Occupational Low Back Pain. Spine. 2012;37:1708–1718.
-
18.
Graves J, Fulton-Kehoe D, et al. Early Imaging for Acute Low Back Pain: One-Year Health and Disability Outcomes Among Washington State Workers. E Spine. 2012;37:1617–1627.
-
19.
Jarvik JG, Hollingworth W, Martin B, et al. Rapid magnetic resonance imaging vs radiographs for patients with low back pain. JAMA. 2003;289:2810–8.
-
20.
Lurie JD, Birkmeyer NJ, Weinstein JN. Rates of advanced spinal imaging and spine surgery. Spine. 2003;28:616–20
-
21.
Nguyen T, Randolph D et al, Long-term Outcomes of Lumbar Fusion Among Workers Compensation Subjects: A historical cohort study. Spine. 2011;36:320–331.
| All Time | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1515 | 1515 | 195 |
| Full Text Views | 29 | 29 | 0 |
| PDF Downloads | 0 | 0 | 0 |
