Imaging studies for acute low back pain - When and when not to order them

A focused history and physical examination can identify nearly all patients with acute low back pain who can benefit from imaging studies. Most patien ts, even those with symptoms of nerve root impingement, improves substantia lly within 4 to 6 weeks of symptom onset and do not require such studies. C linical judgement is required when deciding whether a single red flag in th e patient's history is sufficient to warrant x-ray films and laboratory tes ts at the initial visit. If multiple red flags are present, plain films and laboratory tests are usually appropriate at the initial visit. Advance ima ging (CT, MRI, or bone scan) should be reserved for patients who fail to im prove as expected or for cases in which such imaging is necessary to confir m the diagnosis of a suspected disease.