OBJECTIVE: To evaluate an a priori threshold for advanced imaging in patients with spinal pain. DESIGN: Patients with spinal pain in any region for 6 to 52 weeks were assessed to determine if radiologic studies beyond x-ray scans were indicated, including magnetic resonance imaging (MRI), computed tomography (CT), and radionuclide bone scans. An a priori threshold was set before MRI, CT, or bone scans would be considered. Those who did not have MRI, CT, or bone scans ordered were followed for at least 1 year to determine if any of them went on to be diagnosed with a more serious spinal disorder (eg, infection, fracture, spondylitis, tumour, neurologic compression). SETTING: Four large primary care clinics in Edmonton, Alta. PARTICIPANTS: A total of 1003 consecutively presenting patients with symptoms suspected to be related to the spine (for a duration of generally 6 to 52 weeks) who had not already undergone advanced imaging and did not have a diagnosis of nonbenign back pain. MAIN OUTCOME MEASURES: Number of cases of nonbenign spinal disorder in participants who underwent advanced imaging and participants who did not undergo advanced imaging (ie, did not have any red flags). RESULTS: There were 399 women (39.8%) and 604 men (60.2%). The mean (SD) age of the group was 47.2 (14.6) years. The mean (SD) duration of symptoms was 15.1 (8.6) weeks. Of the 1003 participants, 110 met an a priori threshold for undergoing at least 1 of MRI, CT, or bone scan. In these 110 participants, there were newly diagnosed cases of radiculopathy (n = 12), including a case of cauda equina syndrome; spondyloarthropathy (n = 6); occult fracture (n = 2); solitary metastasis (n = 1); epidural lipomatosis (n = 1); osteomyelitis (n = 1), and retroperitoneal hematoma (n = 1), each of which was considered likely to be the cause of the patient's spinal symptoms. The remaining 893 participants were followed for at least 1 year and none showed evidence of a nonbenign cause of his or her spinal pain. CONCLUSION: In the evaluation of nonspecific spinal pain and symptoms, setting and following an a priori threshold for ordering MRI, CT, or bone scans in the spirit of the current Choosing Wisely Canada recommendations has a very low risk of missing a case of a serious cause of back pain.
OBJECTIVE: To evaluate an a priori threshold for advanced imaging in patients with spinal pain. DESIGN:Patients with spinal pain in any region for 6 to 52 weeks were assessed to determine if radiologic studies beyond x-ray scans were indicated, including magnetic resonance imaging (MRI), computed tomography (CT), and radionuclide bone scans. An a priori threshold was set before MRI, CT, or bone scans would be considered. Those who did not have MRI, CT, or bone scans ordered were followed for at least 1 year to determine if any of them went on to be diagnosed with a more serious spinal disorder (eg, infection, fracture, spondylitis, tumour, neurologic compression). SETTING: Four large primary care clinics in Edmonton, Alta. PARTICIPANTS: A total of 1003 consecutively presenting patients with symptoms suspected to be related to the spine (for a duration of generally 6 to 52 weeks) who had not already undergone advanced imaging and did not have a diagnosis of nonbenign back pain. MAIN OUTCOME MEASURES: Number of cases of nonbenign spinal disorder in participants who underwent advanced imaging and participants who did not undergo advanced imaging (ie, did not have any red flags). RESULTS: There were 399 women (39.8%) and 604 men (60.2%). The mean (SD) age of the group was 47.2 (14.6) years. The mean (SD) duration of symptoms was 15.1 (8.6) weeks. Of the 1003 participants, 110 met an a priori threshold for undergoing at least 1 of MRI, CT, or bone scan. In these 110 participants, there were newly diagnosed cases of radiculopathy (n = 12), including a case of cauda equina syndrome; spondyloarthropathy (n = 6); occult fracture (n = 2); solitary metastasis (n = 1); epidural lipomatosis (n = 1); osteomyelitis (n = 1), and retroperitoneal hematoma (n = 1), each of which was considered likely to be the cause of the patient's spinal symptoms. The remaining 893 participants were followed for at least 1 year and none showed evidence of a nonbenign cause of his or her spinal pain. CONCLUSION: In the evaluation of nonspecific spinal pain and symptoms, setting and following an a priori threshold for ordering MRI, CT, or bone scans in the spirit of the current Choosing Wisely Canada recommendations has a very low risk of missing a case of a serious cause of back pain.
Authors: N Boos; N Semmer; A Elfering; V Schade; I Gal; M Zanetti; R Kissling; N Buchegger; J Hodler; C J Main Journal: Spine (Phila Pa 1976) Date: 2000-06-15 Impact factor: 3.468
Authors: Jeffrey G Jarvik; William Hollingworth; Brook Martin; Scott S Emerson; Darryl T Gray; Steven Overman; David Robinson; Thomas Staiger; Frank Wessbecher; Sean D Sullivan; William Kreuter; Richard A Deyo Journal: JAMA Date: 2003-06-04 Impact factor: 56.272