Imaging of Low Back Pain-Help From The American College of Radiology

In this post, I link to the 27 page PDF, American College of Radiology ACR Appropriateness Criteria® Low Back Pain. Revised 2021.

There are seven variants with imaging recommendations in the above resource. Each of these variants is accompanied by a table of appropriate imaging recommendations.

These variants are:

Variant 1:

Acute low back pain with or without radiculopathy. No red flags. No prior management. Initial imaging.

Variant 2:

Subacute or chronic low back pain with or without radiculopathy. No red flags. No prior management. Initial imaging.

Variant 3:

Subacute or chronic low back pain with or without radiculopathy. Surgery or intervention candidate with persistent or progressive symptoms during or following 6 weeks of optimal medical management. Initial imaging.

Variant 4:

Low back pain with suspected cauda equina syndrome*. Initial imaging

*Cauda Equina and Conus Medullaris Syndromes
Updated: Jun 13, 2018 from emedicine.medscape.com
Author: Segun Toyin Dawodu, JD, MD, MS, MBA, LLM, FAAPMR, FAANEM

Variant 5:

Low back pain with history of prior lumbar surgery and with or without radiculopathy. New or progressing symptoms or clinical findings. Initial imaging.

Variant 6:

Low back pain with or without radiculopathy. One or more of the following: low-velocity trauma, osteoporosis, elderly individual, or chronic steroid use. Initial imaging.

Variant 7:

Low back pain with or without radiculopathy. One or more of the following: suspicion of cancer, infection, or immunosuppression. Initial imaging.

Be sure and read the Summary Of Literature Review, pp. 6-22 of the PDF.

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