What are the ACR Appropriateness Criteria for lower back pain imaging?

Updated: Aug 27, 2020
  • Author: Debra G Perina, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Answer

The ACR Appropriateness Criteria includes the following recommendations [5] :

  • Uncomplicated acute low back pain and/or radiculopathy are benign, self-limited conditions that do not warrant any imaging studies.

  • MRI of the lumbar spine should be considered for those patients presenting with red flags raising suspicion for a serious underlying condition, such as cauda equina syndrome, malignancy, or infection.

  • In patients with a history of low-velocity trauma, osteoporosis, or chronic steroid use, initial evaluation with radiographs is recommended.

  • In the absence of red flags, first-line treatment for chronic low back pain remains conservative therapy with both pharmacologic and nonpharmacologic (eg, exercise, remaining active) therapy.

  • If there are persistent or progressive symptoms during or following 6 weeks of conservative management and the patient is a surgery or intervention candidate or diagnostic uncertainty remains, MRI of the lumbar spine has become the initial imaging modality of choice in evaluating complicated low back pain.

  • MRI is the imaging procedure of choice in patients suspected of cord compression or spinal cord injury.

  • Patients with recurrent low back pain and history of prior surgical intervention should be evaluated with contrast-enhanced MRI.


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