Appropriate use of lumbar imaging for evaluation of low back pain
Abstract
Use of lumbar spine imaging, particularly advanced imaging, continues to grow rapidly in the United States. Many lumbar spine imaging tests are obtained in patients who have no clinical symptoms or risk factors suggesting a serious underlying condition, yet evidence shows that this routine imaging is not associated with benefits, exposes patients to unnecessary harms, and increases costs. This article reviews current trends and practice patterns in lumbar spine imaging, direct and downstream costs, benefits and harms, current recommendations, and potential strategies for reducing imaging overuse.
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For many patients with chronic low back pain, pain is not clearly associated with identifiable pathology of the spine or its soft tissues.
“Although some patients with cLBP may have clear pathoanatomic etiologies, for many there is no clear association between pain and identifiable pathology of the spine or its associated soft tissues.26”
From Report of the NIH Task Force on research standards for chronic low back pain. (2014) · cites this paper as [26]
Degenerative changes seen on spine imaging are only weakly associated with patient symptoms or function.
“No laboratory or imaging tests were highly ranked, because of the widely recognized weak association between degenerative spine changes on imaging and patient symptoms or function.26”
From Report of the NIH Task Force on research standards for chronic low back pain. (2014) · cites this paper as [26]
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References 115 · Cited by 165
- Authors
- Chou, R., Deyo, R. A., & Jarvik, J. G.
- Affiliations
- Oregon Health & Science University (US)
- University of Washington (US)
- Corresponding author
- Chou, Roger
- Venue
- Radiologic Clinics of North America
- Publisher
- Elsevier BV
- Published
- 2012-07
- Volume
- 50
- Issue
- 4
- Pages
- 569-585
- ISSN
- 0033-8389 (ISSN-L)
- OpenAlex
- W1982864832
- Cited by
- 165
- References
- 115
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 3 · 2023: 12 · 2022: 19 · 2021: 12 · 2020: 17 · 2019: 13 · 2018: 16 · 2017: 17 · 2016: 12 · 2015: 11 · 2014: 10 · 2013: 11 · 2012: 1
- FWCI
- 1.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Radiologic Clinics of North America (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
- Keywords
- low back pain, lumbar spine imaging, overuse of imaging, diagnostic imaging utilization, imaging costs, clinical practice patterns, imaging guidelines, cost-effectiveness
- MeSH terms
- Humans, Lumbar Vertebrae, Magnetic Resonance Imaging, Practice Patterns, Physicians', Spinal Diseases, Tomography, X-Ray Computed, United States, Low Back Pain, Unnecessary Procedures
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