TY - JOUR
T1 - ACR Appropriateness Criteria Low Back Pain
AU - Patel, Nandini D.
AU - Broderick, Daniel F.
AU - Burns, Judah
AU - Deshmukh, Tejaswini K.
AU - Fries, Ian Blair
AU - Harvey, H. Benjamin
AU - Holly, Langston
AU - Hunt, Christopher H.
AU - Jagadeesan, Bharathi D.
AU - Kennedy, Tabassum A.
AU - O'Toole, John E.
AU - Perlmutter, Joel S.
AU - Policeni, Bruno
AU - Rosenow, Joshua M.
AU - Schroeder, Jason W.
AU - Whitehead, Matthew T.
AU - Cornelius, Rebecca S.
AU - Corey, Amanda S.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Most patients presenting with uncomplicated acute low back pain (LBP) and/or radiculopathy do not require imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture, and infection. Many imaging modalities are available to clinicians and radiologists for evaluating LBP. Application of these modalities depends largely on the working diagnosis, the urgency of the clinical problem, and comorbidities of the patient. When there is concern for fracture of the lumbar spine, multidetector CT is recommended. Those deemed to be interventional candidates, with LBP lasting for > 6 weeks having completed conservative management with persistent radiculopathic symptoms, may seek MRI. Patients with severe or progressive neurologic deficit on presentation and red flags should be evaluated with MRI. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
AB - Most patients presenting with uncomplicated acute low back pain (LBP) and/or radiculopathy do not require imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture, and infection. Many imaging modalities are available to clinicians and radiologists for evaluating LBP. Application of these modalities depends largely on the working diagnosis, the urgency of the clinical problem, and comorbidities of the patient. When there is concern for fracture of the lumbar spine, multidetector CT is recommended. Those deemed to be interventional candidates, with LBP lasting for > 6 weeks having completed conservative management with persistent radiculopathic symptoms, may seek MRI. Patients with severe or progressive neurologic deficit on presentation and red flags should be evaluated with MRI. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
KW - Appropriateness Criteria
KW - low back pain
KW - radiculopathy
KW - red flags
UR - http://www.scopus.com/inward/record.url?scp=84991108049&partnerID=8YFLogxK
U2 - 10.1016/j.jacr.2016.06.008
DO - 10.1016/j.jacr.2016.06.008
M3 - Article
C2 - 27496288
AN - SCOPUS:84991108049
SN - 1546-1440
VL - 13
SP - 1069
EP - 1078
JO - Journal of the American College of Radiology
JF - Journal of the American College of Radiology
IS - 9
ER -