Teaching Points
- The diagnostic yield of indiscriminate radiography for the assessment of acute low back pain is low
- ‘Red Flags’ that prompt imaging include - Recent significant trauma (mild trauma if age ≥ 50), unexplained weight loss, fever, history of malignancy or immune compromise, intravenous drug use, osteoporosis or glucocorticoid use, suspicion of ankylosing spondylitis, Age > 70 and compensation/work injury issues
- If there are no ‘Red Flags’, imaging is required only after a period of conservative therapy is trialed first
- Initial radiography is with plain films
- If symptoms persist and occult fracture, osteomyelitis or metastaic bone disease is suspected a bone scan or MRI may be considered
- If there are neurological symptoms or signs, MRI of the spine may be preferable
- If MRI is unavailable CT or CT myelography are alternatives
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