Influence of imaging on clinical decision making in the treatment of lowerback pain

PURPOSE: To assess the impact of cross-sectional imaging with magnetic reso nance (MR) imaging or computed tomography (CT) on clinical decision making for patients with lower back pain (LBP). MATERIALS AND METHODS: A randomized controlled before-and-after study was p erformed in 145 patients who had symptomatic lumbar spinal disorders and ha d been referred to orthopedists or neurosurgeons. Participants were a subgr oup within a multicenter pragmatic randomized comparison of two imaging pol icies on LBP treatment: "imaging" versus "no imaging," unless a clear indic ation developed. Paired assessments were made of diagnosis, diagnostic conf idence, proposed treatment, treatment confidence at trial entry acid follow -up, and expectations of imaging. Data were analyzed according to the group s as randomized. RESULTS: At follow-up, there were no statistically significant differences between the groups with respect to diagnosis or treatment plans. Significan t increases in diagnostic and therapeutic confidence between trial entry an d follow-up were observed for both groups, with a significantly greater inc rease in diagnostic confidence (P = .01) in the imaging group. CONCLUSION: Imaging may increase diagnostic confidence but has minimal infl uence on diagnostic or therapeutic decisions for patients with LBP. The res ults highlight the need for evidence-based guidelines for imaging in LBP tr eatment.