Choosing Wisely:

Don’t recommend imaging of the spine within the first six weeks of an acute episode of low back pain in the absence of red flags.

Rationale and Comments: Red flags include, but are not limited to: trauma history, unintentional weight loss, immunosuppression, history of cancer, intravenous drug use, steroid use, fracture, infection, deformity, osteoporosis or osteopenia, progressive paresthesias or weakness involving the pelvis and lower extremities, urinary retention, saddle anesthesia, age > 50, focal neurologic deficit, and progression of symptoms.
Sponsoring Organizations:
  • North American Spine Society
  • Sources:
  • ACP/APS guidelines
  • Disciplines:
  • Orthopedic
  • References: • Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct 2;147(7):478-91.
    • Forseen S, Corey A. Clinical decision support and acute low back pain: evidence-based order sets. J Am Coll Radiol. 2012 Oct;9(10):704-12. • Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018; doi: 10.1007/s00586-018-5673-2. [Epub ahead of print].

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