Back Pain

Radiologic procedure

Rating^a

Comments

X-ray lumbar spine

Initial study of choice especially in setting of osteoporosis or osteoporosis risk factors

CT lumbar spine without contrast

If suspicion for fracture is high and X-ray is negative

MRI lumbar spine without contrast

Can evaluate for ligamentous injury or in setting of worsening neuro deficit

Tc-99m bone scan with SPECT spine

Can uncover radiographically occult fractures

CT lumbar spine with contrast

CT lumbar spine with/without contrast

X-ray myelography and post-myelography CT lumbar spine

X-ray discography and post-discography

CT lumbar spine

^aRating scale: 1, 2, and 3 usually not appropriate; 4, 5, and 6 may be appropriate; 7, 8, and 9 usually appropriate

Scenario 2

Acute, subacute, or chronic low back pain or radiculopathy. One or more of the following: suspicion of cancer, infection, or immunosuppression

Radiologic procedure	Rating^a	Comments
MRI lumbar spine with/without contrast	8	Contrast helps for cancer patients suspected of epidural or intraspinal disease
MRI lumbar spine without contrast	7	Sufficient if low risk of epidural or intraspinal disease
CT lumbar spine with contrast	6	If MRI is contraindicated
CT lumbar spine without contrast	6	If MRI is contraindicated
X-ray lumbar spine	5
Tc-99m bone scan with SPECT spine	4	Helps with anatomic localization if widespread metastasis is suspected
FDG-PET/CT whole body	4	Can help distinguish benign from malignant compression fractures but MRI is better
CT lumbar spine with/without contrast	3	If MRI is contraindicated
X-ray myelography and post-myelography CT lumbar spine	3	If MRI is contraindicated can be useful for anatomic localization and problem solving

^aRating scale: 1, 2, and 3 usually not appropriate; 4, 5, and 6 may be appropriate; 7, 8, and 9 usually appropriate

Scenario 3

Acute, subacute, or chronic low back pain or radiculopathy. Surgery or intervention candidate with persistent or progressive symptoms during or following 6 weeks of conservative management

Radiologic procedure	Rating^a	Comments
MRI lumbar spine without contrast	8
CT lumbar spine with contrast	5	If MRI is contraindicated
CT lumbar spine without contrast	5	If MRI is contraindicated
MRI lumbar spine with/without contrast	5	If MRI without contrast is nondiagnostic or if history of prior lumbar surgery
X-ray lumbar spine	4	Usually not sufficient by itself but can help with surgical planning
Tc-99m bone scan with SPECT spine	4	Useful for facet arthropathy or stress fracture
X-ray discography and post-discography
CT lumbar spine	3	Controversial, but may be helpful in patients with pain >3 months

^aRating scale: 1, 2, and 3 usually not appropriate; 4, 5, and 6 may be appropriate; 7, 8, and 9 usually appropriate

Scenario 4

Low back pain or radiculopathy. New or progressing symptoms or clinical findings with history of prior lumbar surgery

Radiologic procedure	Rating^a	Comments
MRI lumbar spine with/without contrast	8	Can differentiate disc from scar
CT lumbar spine with contrast	6	Useful in postfusion patients or when MRI is contraindicated or nondiagnostic Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Related Related posts: Hemoptysis Abdominal Pain Irritable Bowel Syndrome Acute Pelvic Pain Dysmenorrhea Insomnia Tags: Primary Care for Emergency Physicians Nov 20, 2017 \| Posted by admin in Uncategorized \| Comments Off on Back Pain Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access