Subacute to chronic uncomplicated (no red flags) LBP, with or without radiculopathy, is considered a self-limiting condition responsive to medical management and physical therapy in most patients [4,6,7]. Numerous studies have shown that routine imaging provides no clinical benefit in this group [6,9] and can lead to increased health care utilization [6,17]. Radiography Lumbar Spine There is no relevant literature to support the use of radiography in the initial evaluation of patients in this group. Subacute to chronic uncomplicated (no red flags) LBP, with or without radiculopathy, is considered a self-limiting condition responsive to medical management and physical therapy in most patients [4,6,7]. Numerous studies have shown that routine imaging provides no clinical benefit in this group [6,9] and can lead to increased health care utilization [6,17]. Variant 3: Subacute or chronic low back pain with or without radiculopathy. Surgery or intervention candidate with persistent or progressive symptoms during or following 6 weeks of optimal medical management. Initial imaging. In the absence of red flags, first-line treatment for chronic LBP remains conservative therapy with both pharmacologic and nonpharmacologic (eg, exercise, remaining active) therapy [19]. However, patients presenting with subacute or chronic LBP, with or without radiculopathy, who have failed 6 weeks of conservative therapy should be imaged if they are believed to be candidates for surgery or intervention or if diagnostic uncertainty remains. The goal of imaging is to identify potential actionable pain generators that could be targeted for intervention or surgery. MRI of the lumbar spine has become the initial imaging modality of choice in these patients. MRI has excellent soft-tissue contrast and accurately depicts lumbar pathology, including disc degeneration, as well as the thecal sac and neural structures [7].
Low Back Pain PCAs. Subacute to chronic uncomplicated (no red flags) LBP, with or without radiculopathy, is considered a self-limiting condition responsive to medical management and physical therapy in most patients [4,6,7]. Numerous studies have shown that routine imaging provides no clinical benefit in this group [6,9] and can lead to increased health care utilization [6,17]. Radiography Lumbar Spine There is no relevant literature to support the use of radiography in the initial evaluation of patients in this group. Subacute to chronic uncomplicated (no red flags) LBP, with or without radiculopathy, is considered a self-limiting condition responsive to medical management and physical therapy in most patients [4,6,7]. Numerous studies have shown that routine imaging provides no clinical benefit in this group [6,9] and can lead to increased health care utilization [6,17]. Variant 3: Subacute or chronic low back pain with or without radiculopathy. Surgery or intervention candidate with persistent or progressive symptoms during or following 6 weeks of optimal medical management. Initial imaging. In the absence of red flags, first-line treatment for chronic LBP remains conservative therapy with both pharmacologic and nonpharmacologic (eg, exercise, remaining active) therapy [19]. However, patients presenting with subacute or chronic LBP, with or without radiculopathy, who have failed 6 weeks of conservative therapy should be imaged if they are believed to be candidates for surgery or intervention or if diagnostic uncertainty remains. The goal of imaging is to identify potential actionable pain generators that could be targeted for intervention or surgery. MRI of the lumbar spine has become the initial imaging modality of choice in these patients. MRI has excellent soft-tissue contrast and accurately depicts lumbar pathology, including disc degeneration, as well as the thecal sac and neural structures [7].