Imaging strategies for low-back pain: systematic review and meta-analysis.

Chou R, Fu R, Carrino JA, Deyo RA.

This study investigated the effects of routine, immediate lumbar imaging versus usual clinical care without immediate imaging on clinical outcomes in patients with low-back pain and no indication of serious underlying conditions. Randomised controlled trials that compared immediate lumbar imaging (radiography, MRI, or CT) versus usual clinical care without immediate imaging for low-back pain were analysed. Six trials  met inclusion criteria. Significant differences between immediate lumbar imaging and usual care without immediate imaging for primary outcomes at either short-term or long-term follow-up were not recorded. Other outcomes did not differ significantly. Trial quality, use of different imaging methods, and duration of low-back pain did not affect the results, but analyses were limited by small numbers of trials.

Lumbar imaging for low-back pain without indications of serious underlying conditions does not improve clinical outcomes. Therefore, clinicians should refrain from routine, immediate lumbar imaging in patients with acute or subacute low-back pain and without features suggesting a serious underlying condition.

Lancet, 2009, 373(9662), 463-72.

Link to abstract

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