Acute Low Back Pain Indications for MR Imaging

Uncomplicated acute low back pain is a benign, self-limited condition that does not warrant any imaging studies. The vast majority of these patients are back to their usual activities in 30 days. The challenge to the physician is to distinguish that small segment within this large patient population that should be evaluated further because of suspicion of a more serious problem.

So called red flags that may indicate a need for earlier imaging with MRI:

(1) recent significant trauma, or milder trauma age >50

(2) unexplained weight loss

(3) unexplained fever

(4) immunosuppression

(5) history of cancer

(6) IV drug use

(7) prolonged use of corticosteroids, osteoporosis

(8) age >70

We are recommending not imaging uncomplicated acute low back pain prior to 30 days and we are tracking these patients for appropriateness for MR imaging.

MR is considered the study of choice for the evaluation of complicated low back pain. The most common indications are radiating pain (sciatica or radiculopathy) or cauda equina syndrome (bilateral leg weakness, urinary retention, saddle anesthesia), usually due to herniated disc and or canal stenosis.