Guidelines advise limiting radiographs
Usefulness confined to possible fracture, cancer
The back pain guidelines from the Agency for Health Care Policy and Research (AHCPR) in Washington, DC, recommend using lumbar radiographs to diagnose low back pain when there is a possibility that the pain is associated with spinal fracture, cancer, or infection. To know when the radiograph is appropriate, the agency suggests looking for specific "red flags" that mean the patient may have one of those serious conditions.1
For spinal fracture, the AHCPR advises looking for these red flags that should trigger a lumbar radiograph:
- major trauma, such as a motor vehicle accident or fall from height;
- minor trauma or even strenuous lifting when the patient is older or potentially osteoporotic;
- prolonged steroid use;
- osteoporosis;
- age greater than 70 years.
For cancer or infections, the AHCPR suggests using a lumbar radiograph if you see one of these warning signs:
- age greater than 50 or younger than 20;
- history of cancer;
- constitutional symptoms, such as a recent fever, chills, or unexplained weight loss;
- the existence of risk factors for spinal infection, including recent bacterial infection, intravenous drug use, and immunosuppression;
- severe nighttime pain or pain that is worse when supine.
Reference
1. Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults: Clinical Practice Guideline Number 14. Rockville, MD: U.S. Dept. Of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; 1994. AHCP publication 95-0642.
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