Importance of Imaging in Low Back Pain

Radiologists utilize imaging studies to accurately diagnose a variety of causes of low

back pain. In primary care, the most commonly used imaging modalities are X-ray, MRI, CT, and

nuclear medicine bone scan. Sometimes, more advanced imaging techniques are used in

anticipation for surgery and that includes CT myelography and PET scans.

By having specialized training with these techniques radiologists are able to provide

assistance to surgeons and other medical practitioners. X-rays are helpful for evaluation of

fracture, bony deformity including degenerative changes, sacroiliitis, disk and vertebral body

height, and assessment of bony density and architecture. MRI or CT is recommended in

patients with severe or progressive neurologic deficits or with serious underlying conditions,

such as vertebral infection, cauda equine syndrome, or cancer with spinal cord compression.

MRI does not require radiation exposure and provides better visualization of soft tissue and

spinal canal, and thus preferred over CT. Computed tomography (CT) has superior depiction of

cortical bone than MRI. It may be better in visualizing fractures and detecting facet

degenerative changes. Bone scans are used mainly to detect occult fractures, stress fractures,

infections, or bony metastases and to differentiate them from degenerative changes.

Radiologists can take patient findings and correlate them with the appropriate imaging

studies to provide diagnoses, further diagnostic studies if needed, and possibly a treatment

plan.

Author 1: Braden Stoeger UWSP Biology Major

Author 2: Kunal Patel, MD

References

Harwood MI, Smith BJ. Low back pain: a primary care approach. Clin Fam Pract.

2005;7(2):279–303. doi: 10.1016/j.cfp.2005.02.010.

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.

Ann Intern Med. 2007 Oct 2; 147(7):478-91.

Jarvik JG, Deyo RA. Ann Intern Med. 2002 Oct 1; 137(7):586-97.