Download AMERICAN COLLEGE OF RADIOLOGY GUIDELINES FOR LOW

Low Back Pain Imaging Guidelines
From the Desk of Dr. Sara Liter-Kuester
Please refer to these Red Flag guidelines as a reminder of appropriate use of imaging for Low Back
Pain. More information is available in the Low Back Pain Management Kit available from
Mercy Physician Community PHO.
AMERICAN COLLEGE OF RADIOLOGY
GUIDELINES FOR LOW BACK PAIN - DIAGNOSTIC IMAGING
VARIANT
1
Uncomplicated acute low back
pain and/or radiculopathy (no red
flags)
RECOMMENDED
PROCEDURE
ALTERNATIVE
PROCEDURES
•No imaging recommended
*The vast majority of patients with uncomplicated LBP (low back pain) return to their usual
activities within 30 days. Indications or “red flags” of a more complicated status may
warrant the following imaging procedures:
2
Low velocity trauma,
osteoporosis, and/or Age >70 yrs.
•MRI lumbar spine without contrast
•CT lumbar spine without contrast
•X-ray lumbar spine
•MRI lumbar spine without and with
contrast
•CT lumbar spine without contrast
if MRI is contraindicated
•X-ray lumbar spine
•MRI lumbar spine without contrast
•CT lumbar spine without contrast
•MRI lumbar spine with contrast if
noncontrast MRI is indeterminate
•MRI lumbar spine without and with
contrast
•CT lumbar spine without contrast
if MRI is contraindicated
•MRI lumbar spine without contrast
3
Suspicion of cancer,infection
or immune-suppression
4
Low back pain and/or
radiculopathy > 6 weeks, surgery
or inter-vention candidate
5
Prior lumbar surgery
6
Cauda equine syndrome
•MRI lumbar spine without contrast
•MRI lumbar spine without and with
contrast
•Myelography and post-myelography
CT lumbar spine
Along with the guidelines for diagnostic imaging, here are some treatment tips for acute low back pain.
PHARMACEUTICAL
TREATMENT
•Prescribe OTC oral analgesics on a
time contingent basis not pain
cotingent basis.
Acetaminophen is recommended for its few
side effects. NSAIDS including ibuprophen
and enteric coated aspirin are second line
agents due to potential for gastric irritation.
NON PHARMACEUTICAL
TREATMENT
•Limit bed rest beyond 2 days
•Encourage low stress aerobic activity (walking,
swimming, stationary biking) and gradual stretching
as tolerated as well as avoidance of activities that
cause back irritation.
•Apply cold (ice packs) initially for 1-2 days
followed by heat applications.
Manipulation may be helpful in the first month of treatment.
PATIENT EDUCATION
•Encourage positive expectation
of recovery
•Teach safe and effective methods of
symptom control,
activity modification
and strengthening
back exercises.