The recommendations on X-rays from the AHCPR
guidelines are offered in their original form. No further review of
evidence was undertaken.
Plain X-rays are not recommended for routine
evaluation of patients with acute low back problems within the first
month of symptoms unless a red flag is noted on clinical
examination. (B)
Plain X-rays of the lumbar spine are recommended
for ruling out fractures in patients with acute low back problems
when any of the following red flags are present: recent significant
trauma (any age), recent mild trauma (patient over age 50), history
of prolonged steroid use, osteoporosis, patient over age 70. (C)
Plain X-rays in combination with FBC and ESR may
be useful for ruling out tumour or infection in patients with acute
low back problems when any of the following red flags are present:
prior cancer or recent infection, fever over 100°
F, IV drug abuse, prolonged steroid use, low back pain worse with
rest, unexplained weight loss. (C)
In the presence of red flags, especially for
tumour or infection, the use of other imaging studies such as bone
scan, CT, or MRI may be clinically indicated even if plain X-rays
are negative. (C)
A bone scan is recommended to evaluate acute low
back problems when spinal tumour, infection, or occult fracture is
suspected from red flags on medical history, physical examination,
corroborative lab test or plain X-ray findings. Bone scans are
contraindicated during pregnancy. (C)
The routine use of oblique views on plain lumbar
X-rays is not recommended for adults in light of the increased
radiation exposure. (B)
The Royal College of Radiologists’ guidelines (2nd, 3rd and
4th editions) are based on consensus and are not directly linked to
evidence.
