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Guidelines for Lumbar Radiographs in Early Diagnosis of Low Back Pain

Description

Guidelines for the use of lumbar radiographs in the diagnosis of acute low back pain (of less than 3 month duration) have been published by the Agency for Health Care Policy and Research (AHCPR). Radiographs are recommended if there is a risk factor for spinal fracture, tumor or infection.


 

 

Possible Diagnosis

Red Flags

spinal fracture

major trauma (vehicle accident, fall from height, etc.)

 

minor trauma or strenuous lifting in older, potentially osteoporotic patients (age > 50 years of age)

 

prolonged steroid use

 

osteoporosis

 

age > 70 years

tumor or infection

age > 50 years of age, or < 20 years of age

 

history of cancer

 

constitutional symptoms such as recent fever, chills or unexplained weight loss

 

risk factors for spinal infection (recent bacterial infection, intravenous drug use, immunosuppression)

 

pain that is worse when supine, or severe nighttime/nocturnal pain

 

Limitations:

• The guidelines are sensitive (100%) but have low specificity (56%) and positive predictive value (1.9%), resulting in increased utilization and cost.

 


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