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J Am Coll Radiol. 2016 Sep;13(9):1069-78. doi: 10.1016/j.jacr.2016.06.008. Epub 2016 Aug 3.

ACR Appropriateness Criteria Low Back Pain.

Author information

1
Fairfax Radiology Consultants PC, Fairfax, Virginia. Electronic address: nandini416@gmail.com.
2
Mayo Clinic Jacksonville, Jacksonville, Florida.
3
Montefiore Medical Center, Bronx, New York.
4
Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
5
Bone, Spine and Hand Surgery, Chartered, Brick, New Jersey, American Academy of Orthopaedic Surgeons.
6
Massachusetts General Hospital, Boston, Massachusetts.
7
UCLA Medical Center, Los Angeles, California, neurosurgical consultant.
8
Mayo Clinic, Rochester, Minnesota.
9
University of Minnesota, Minneapolis, Minnesota.
10
University of Wisconsin Hospital and Clinic, Madison, Wisconsin.
11
Rush University, Chicago, Illinois, neurosurgical consultant.
12
Washington University School of Medicine, St Louis, Missouri, American Academy of Neurologists.
13
University of Iowa Hospitals and Clinics, Iowa City, Iowa.
14
Northwestern University Feinberg School of Medicine, Chicago, Illinois, neurosurgical consultant.
15
Walter Reed National Military Medical Center, Bethesda, Maryland.
16
Children's National Medical Center, Washington, District of Columbia.
17
University of Cincinnati, Cincinnati, Ohio.
18
Emory University, Atlanta, Georgia.

Abstract

Most patients presenting with uncomplicated acute low back pain (LBP) and/or radiculopathy do not require imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture, and infection. Many imaging modalities are available to clinicians and radiologists for evaluating LBP. Application of these modalities depends largely on the working diagnosis, the urgency of the clinical problem, and comorbidities of the patient. When there is concern for fracture of the lumbar spine, multidetector CT is recommended. Those deemed to be interventional candidates, with LBP lasting for > 6 weeks having completed conservative management with persistent radiculopathic symptoms, may seek MRI. Patients with severe or progressive neurologic deficit on presentation and red flags should be evaluated with MRI. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

KEYWORDS:

Appropriateness Criteria; low back pain; radiculopathy; red flags

PMID:
27496288
DOI:
10.1016/j.jacr.2016.06.008
[Indexed for MEDLINE]

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