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20 Imaging of Adults with Low Back Pain in the Primary Care Setting

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Evidence-Based Imaging

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Key Points

The natural history of low back pain (LBP) is typically benign; in the absence of “red flags,” imaging can safely be limited to a minority of patients with LBP in the primary care setting (strong evidence). LBP imaging is often performed to rule out a serious etiology, especially metastases. While the first-line study is plain radiographs, magnetic resonance (MR) is more sensitive. However, initial imaging with MR has not yet proven to be cost-effective (moderate evidence). Many incidental findings are discovered when imaging the lumbar spine, including disk desiccation, annular tears, bulging disks, and herniated disks. Their eventual correlation with back pain is not known. However, while disk bulges and protrusions are common in asymptomatic individuals, extrusions are not (strong evidence). Imaging can diagnose surgically treatable causes of radiculopathy (herniated disks and spinal stenosis). However, these are typically not the causes of LBP and are often incidental findings in asymptomatic individuals; furthermore, the long-term efficacy of corrective surgery for these conditions has not been established (moderate evidence). Vertebroplasty is not better than local anesthetic injection for the treatment of painful osteoporotic compression fractures and should not be routinely performed (strong evidence).

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Acknowledgment:

This work is supported in part by grant 1 P60 AR48093 from the National Institute for Arthritis, Musculoskeletal, and Skin Diseases.

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  1. Department of Radiology, University of Washington, Seattle, WA, 98195, USA

    Jeffrey G. Jarvik

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  1. Marla B. K. Sammer
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Correspondence to Jeffrey G. Jarvik .

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Editors and Affiliations

  1. , Department of Radiology, Miami Children's Hospital, SW 114 Street 7420, Miami, 33156, Florida, USA

    L. Santiago Medina

  2. Harborview Medical Center, Department of Radiology, University of Washington, Ninth Avenue 325, Seattle, 98104-2499, Washington, USA

    C. Craig Blackmore

  3. , Department of Radiology, Emory University School of Medicine, 1364 Clifton Road, NE Suite D112, Atlanta, 30322, USA

    Kimberly Applegate

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Sammer, M.B.K., Jarvik, J.G. (2011). 20 Imaging of Adults with Low Back Pain in the Primary Care Setting. In: Medina, L., Blackmore, C., Applegate, K. (eds) Evidence-Based Imaging. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7777-9_20

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