II. Precautions

  1. Imaging of the spine has an increasing False Positive Rate in older patients
    1. Correlate findings with Low Back Pain History and Low Back Pain Exam
    2. Cheung (2009) Spine 34(9): 934-40 [PubMed]

III. Imaging

  1. Indications
    1. Not recommended for routine Low Back Pain in the first 6 weeks
    2. Obtain for Low Back Pain Red Flag symptoms
    3. Obtain when surgery is being considered
  2. Procedures
    1. Lumbosacral Spine XRay
    2. Lumbar Spine MRI (Most accurate)
    3. Lumbar Spine CT Myelogram (Less accurate than MRI)
    4. Spine Bone Scan

IV. Diagnostics: Electrophysiologic Tests

  1. Indications
    1. Suspected nerve root dysfunction
    2. Persistent leg symptoms beyond 6 weeks
    3. Not recommended if radiculopathy is obvious from exam
  2. Testing
    1. Needle Electromyelogram (EMG)
    2. H-Reflex Tests

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