When to Order CT Scans for Acute Low Back PainDoctors are concerned about the rising costs of health care. Imaging studies are expensive and not always needed. In this study, research shows when doctors should order CT scans for patients with acute low back pain. In most cases, quality of care and patient safety are still preserved when advanced imaging isn't ordered.
One-hundred (100) men and women with acute low back pain were included in this study. Each one was examined by two physicians. The exam included range of motion, leg length, and muscle function. Any changes in sensation were recorded. X-rays and CT scans were also done.
There was no link between clinical findings and results of X-rays. CT scans were normal for 28 patients. The rest of the group had one or more changes observed. The findings included disc bulging, narrowing of the spinal canal (stenosis), or bone spurs.
The authors compared the results of X-rays and CT scans with patients' symptoms and exam findings. Disc bulging was observed on CT scans in one-third of the patients who didn't have any clinical signs of disc problems. For patients who reported sensory changes, only half had actual signs of disc bulging on CT scan. Of the 100 patients in this study, only six had true neurologic problems linked to disc protrusion seen on CT scans.
The authors suggest that advanced imaging should be saved for patients who don't get better or get worse with time or treatment. CT scans should be ordered for the patient with significant neurologic problems at the time of the first exam. This approach saves money without sacrificing results.
Haim Stein, MD, DPhil(Oxon), et al. Low Back Pain. In Orthopedics. March 2006. Vol. 29. No. 3. Pp. 229-231.
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