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Many physicians continue to order lumbar imaging studies for patients with acute low back pain despite consistent guideline opposition to such imaging in the absence of “red flags” suggestive of serious disease (e.g., cancer, infection, cauda equina syndrome). Little evidence indicates that imaging helps with treatment decisions or improves outcomes, and imaging could result in unnecessary radiation and invasive procedures that are directed at anatomic lesions unrelated to back pain.
In a meta-analysis of six randomized trials, investigators compared clinical outcomes in 1804 patients with acute low back pain who were randomized to immediate lumbar imaging (plain radiography, computed tomography, or magnetic resonance imaging) or usual care …