II. Precautions
- Avoid catastrophizing imaging findings
- Imaging often demonstrates asymptomatic changes unrelated to the patients symptoms and signs
- Describing imaging as normal with age related changes benefits patient outcomes
- Better treatment efficacy and higher resulting function
- Rajasekaran (2021) Eur Spine J 30(7): 2069-81 [PubMed]
- Imaging of the spine has an increasing False Positive Rate in older patients
- Correlate findings with Low Back Pain History and Low Back Pain Exam
- Cheung (2009) Spine 34(9): 934-40 [PubMed]
III. Imaging
- See Low Back Pain Red Flags
- Precautions
- A careful history and examination is the most important evaluation measure in Low Back Pain
- Most patients with Acute Low Back Pain will have Musculoskeletal Low Back Pain (95% will resolve within 6 weeks)
- Indications
- Low Back Pain Red Flags
- Prolonged Low Back Pain >6 weeks
- Preoperative spine evaluation
-
Lumbar Spine XRay Indications
- Consider in age over 50 years or under 18 years old, or acute Lumbar Spine Trauma
- Vertebral Fracture
- Spondylolisthesis
-
Lumbar Spine CT Indications
- Spinal Trauma
- Vertebral Fracture
- Vertebral dislocation
- Spondylolisthesis
-
Lumbar Spine MRI Indications (MRI is preferred study in most cases)
- Lumbosacral Radiculopathy >6 weeks despite conservative management
- Spinal Epidural Abscess (Spinal Osteomyelitis)
- Spinal Cord Tumor
- Cauda Equina Syndrome (or spinal stenosis)
- Nontraumatic vascular injuries of the spine
- Other Imaging
- Lumbar Spine CT Myelogram (when MRI is contraindicated)
- Spine Bone Scan
IV. Diagnostics: Electrophysiologic Tests
- Indications: Radiculopathy, Neuropathy, Myelopathy, Myopathy
- Persistent symptoms >6 weeks AND
- Suspected nerve root dysfunction with neuromuscular deficit
- Radicular Pain
- Muscle Weakness
- Sensory Loss
- Muscle atrophy
- Not recommended if radiculopathy is obvious from exam
- Testing
- H-Reflex Tests
- Needle Electromyelogram (EMG)