Table 1.

Current Guidelines on the Use of Imaging for Patients with Acute Low Back Pain

Organization	Guideline/Recommendation
American College of Physicians16,17	Clinicians should not routinely obtain imaging or other diagnostic tests in patients with non-specific acute low back pain*†
American Pain Society17
American College of Radiology15	Acute low back pain without red flags‡ is a benign, self-limiting condition that does not require imaging evaluation
American Academy of Family Physicians18	Without clinical signs of serious pathology, diagnostic imaging is not indicated in patients with acute low back pain
American Chronic Pain Association20	Do not routinely obtain imaging or other diagnostic tests in patients with non-specific low back pain
American Physical Therapy Association, the Orthopaedic Section19	Routine ordering of imaging for low back pain should be discouraged. In particular, imaging in acute low back pain has not been shown to yield significant new findings or alter outcomes.

^* Acute low back pain is defined as low back pain present for fewer than 4 weeks

^† Non-specific low back pain is defined as pain occurring primarily in the back, with no signs of a serious underlying condition (such as cancer, infection, or cauda equina syndrome), spinal stenosis or radiculopathy, or another specific spinal cause (such as vertebral compression fracture or ankylosing spondylitis). Degenerative changes on lumbar imaging are usually considered non-specific, as they correlate poorly with symptoms

^‡ Red flags are defined as one of the following: 1) recent significant trauma or milder trauma at age > 50 years; 2) unexplained weight loss; 3) unexplained fever; 4) immunosuppression; 5) history of cancer or prior surgery; 6) intravenous drug use; 7) prolonged use of corticosteroids or osteoporosis; 8) age > 70 years; 9) focal neurologic deficit with progressive or disabling symptoms; and 10) duration longer than 6 weeks