Choosing Wisely:

Don’t perform repeat imaging to monitor patients’ progress.

Rationale and Comments: With few exceptions (e.g., the long-term management of idiopathic scoliosis) radiographic findings should not be used as outcome measures for low-back pain. There is currently no data available to support a relationship between changes in alignment or other structural characteristics and patient improvement. This practice increases costs, exposes patients unnecessarily to ionizing radiation, and may distract from more meaningful outcomes. Furthermore, there is no known correlation between performing routine or repeat imaging studies to monitor a patient’s condition and improved clinical outcomes or meaningful changes in patient management. Repeat imaging is appropriate only if strong clinical indications exist, such as a major change in diagnosis, documented worsening of symptoms, or significant progression of disease. Failure to respond to treatment is not an indication for repeat imaging.
Sponsoring Organizations:
  • American Chiropractic Association
  • Sources:
  • Systematic review
  • Disciplines:
  • Orthopedic
  • References: • Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6.
    • Matsumoto M, Okada E, Toyama Y, Fujiwara H, Momoshima S, Takahata T. Tandem age-related lumbar and cervical intervertebral disc changes in asymptomatic subjects. Eur Spine J. 2013 Apr;22(4):708-13.
    • Okada E, Matsumoto M, Fujiwara H, Toyama Y. Disc degeneration of cervical spine on MRI in patients with lumbar disc herniation: comparison study with asymptomatic volunteers. Eur Spine J. 2011 Apr;20(4):585-91.
    • Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009 Feb 7;373(9662):463-72.
    • Kendrick D, Fielding K, Bentley E, Kerslake R, Miller P, Pringle M. Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. BMJ 2001 Feb 17; 322(7283): 400-5.
    • Bussières AE, Taylor JA, Peterson C. Diagnostic imaging practice guidelines for musculoskeletal complaints in adults-an evidence-based approach-part 3: spinal disorders. J Manipulative Physiol Ther. 2008 Jan;31(1):33-88.
    • National Guideline Clearinghouse (NGC). Guideline summary: ACR Appropriateness Criteria® low back pain. In: National Guideline Clearinghouse (NGC) [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2001 Jul 31 [updated 2016 Jan 22; cited 2017 May 4]. Available from: https://www.guideline.gov/summaries/summary/49915.

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