The challenge for the clinician, therefore, is to distinguish the small segment within this large patient population that should be evaluated further because of suspicion of a more serious problem or identify pathology that requires intervention. Nonspecific lumbar disc abnormalities are common in asymptomatic patients and can be demonstrated readily on MRI, CT, fluoroscopic myelography, and postmyelography CT of the lumbar spine [11]. Imaging abnormalities can be seen in a substantial number of people without back pain [11-13]. A prospective study by Carragee et al [13] found that among patients with lumbar imaging abnormalities before the onset of LBP, 84% had unchanged or improved findings after symptoms developed. A systematic review of 33 articles found an increasing prevalence of degenerative spine findings in asymptomatic patients of increasing age [12]. For example, disc protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age in this asymptomatic population. A prospective cohort study of 20 patients showed no significant differences in MRI changes over 12 months in patients presenting with acute LBP compared with their asymptomatic counterparts, except in disc herniation, nerve root compression, and annular fissure [15]. Even in the setting of disc herniation, imaging may have limited role in management as the majority of disc herniations show some degree of reabsorption or regression by 8 weeks after symptom onset [16]. It is important to note that repeat imaging in patients with new episodes of LBP and previous MRI scans are unlikely to detect differences in disc protrusion, annular fissures, high-intensity zones, or end-plate signal changes [13]. Bone Scan Whole Body with SPECT or SPECT/CT Complete Spine There is no relevant literature to support the use of bone scan with single-photon emission CT (SPECT) or SPECT/CT in the initial evaluation of acute uncomplicated LBP.
Low Back Pain PCAs. The challenge for the clinician, therefore, is to distinguish the small segment within this large patient population that should be evaluated further because of suspicion of a more serious problem or identify pathology that requires intervention. Nonspecific lumbar disc abnormalities are common in asymptomatic patients and can be demonstrated readily on MRI, CT, fluoroscopic myelography, and postmyelography CT of the lumbar spine [11]. Imaging abnormalities can be seen in a substantial number of people without back pain [11-13]. A prospective study by Carragee et al [13] found that among patients with lumbar imaging abnormalities before the onset of LBP, 84% had unchanged or improved findings after symptoms developed. A systematic review of 33 articles found an increasing prevalence of degenerative spine findings in asymptomatic patients of increasing age [12]. For example, disc protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age in this asymptomatic population. A prospective cohort study of 20 patients showed no significant differences in MRI changes over 12 months in patients presenting with acute LBP compared with their asymptomatic counterparts, except in disc herniation, nerve root compression, and annular fissure [15]. Even in the setting of disc herniation, imaging may have limited role in management as the majority of disc herniations show some degree of reabsorption or regression by 8 weeks after symptom onset [16]. It is important to note that repeat imaging in patients with new episodes of LBP and previous MRI scans are unlikely to detect differences in disc protrusion, annular fissures, high-intensity zones, or end-plate signal changes [13]. Bone Scan Whole Body with SPECT or SPECT/CT Complete Spine There is no relevant literature to support the use of bone scan with single-photon emission CT (SPECT) or SPECT/CT in the initial evaluation of acute uncomplicated LBP.