Diagnostic Imaging Procedures for the Lumbar Spine
Authors: Richard A. Deyo
Journal: Annals of Internal Medicine (1989)

Editorials1 December 1989Diagnostic Imaging Procedures for the Lumbar SpineRichard A. Deyo, MD, Stanley J. Bigos, MD, Kenneth R. Maravilla, MDRichard A. Deyo, MDSearch for more papers by this author, Stanley J. Bigos, MDSearch for more papers by this author, Kenneth R. Maravilla, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-111-11-865 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptLow back pain is an extraordinarily common complaint, but one with a generally favorable prognosis. Most episodes will improve rapidly with little or no medical intervention, and a specific diagnosis can be made in only a few cases (1). Only a very few patients require plain radiography and even fewer patients require more sophisticated imaging procedures. Although a broad range of imaging procedures are commonly used for the lumbar spine (Table 1), many of these procedures overlap in their capabilities, and their optimal choice or sequence remains uncertain. Furthermore, the clinical usefulness of some of these tests remains controversial.Traditional...References1. WhiteGordon AS. Synopsis: workshop on idiopathic low-back pain. Spine. 1982;7:141-9. CrossrefMedlineGoogle Scholar2. Nachemson A. The lumbar spine: an orthopedic challenge. Spine. 1976;1:59-71. CrossrefGoogle Scholar3. DeyoMcNieshCone RLR. Observer variability in the interpretation of lumbar spine radiographs. Arthritis Rheum. 1985;28:1066-70. CrossrefMedlineGoogle Scholar4. Deyo R. Early diagnostic evaluation of low back pain. J Gen Intern Med. 1986;1:328-38. CrossrefMedlineGoogle Scholar5. SpitzerLeBlancDupui WFM. Scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians. Report of the Quebec Task Force on spinal disorders. Spine. 1987;12(7 Suppl):S16-S21. Google Scholar6. DeyoDiehl RA. Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies. J Gen Intern Med. 1988;3:230-8. CrossrefMedlineGoogle Scholar7. EisenbergHedgcockWilliams RME. Optimum radiographic examination for consideration of compensation awards: II. Cervical and lumbar spines. AJR. 1980;135:1071-4. CrossrefMedlineGoogle Scholar8. GehweilerDaffner JR. Low back pain: the controversy of radiologic evaluation. AJR. 1983;140:109-12. CrossrefMedlineGoogle Scholar9. ScavoneLatshawWeidner JRW. Anteroposterior and lateral radiographs: an adequate lumbar spine examination. AJR. 1981;136:715-7. CrossrefMedlineGoogle Scholar10. EisenbergAkinHedgcock RJM. Single, well centered lateral view of lumbosacral spine: is coned view necessary? AJR. 1979;133:711-3. CrossrefMedlineGoogle Scholar11. . A rational approach to radiodiagnostic investigations. World Health Organization technical report series 689. Geneva: World Health Organization; 1983:31. Google Scholar12. HitselbergerWitten WR. Abnormal myelograms in asymptomatic patients. J Neurosurg. 1968;28:204-6. CrossrefMedlineGoogle Scholar13. WeiselTsourmasFefferCitrinPatronas SNHCN. A study of computer-assisted tomography. I. The Incidence of positive CAT scans in an asymptomatic group of patients. Spine. 1984;9:549-51. CrossrefMedlineGoogle Scholar14. WeinrebWolbarshtCohenBrownMaravilla JLJCK. Prevalence of lumbosacral intervertebral disk abnormalities on MR images in pregnant and asymptomatic nonpregnant women. Radiology. 1989;170:125-8. CrossrefMedlineGoogle Scholar15. HaughtonEldevikMagnaesAmundsen VOBP. A prospective comparison of computed tomography and myelography in the diagnosis of herniated lumbar disks. Radiology. 1982;142:103-10. CrossrefMedlineGoogle Scholar16. Hudgins W. Computer-aided diagnosis of lumbar disc herniation. Spine. 1983;8:604-15. CrossrefMedlineGoogle Scholar17. KentLarson DE. Magnetic resonance imaging of the brain and spine. Is clinical efficacy established after the first decade? Ann Intern Med. 1988;108:402-24. LinkGoogle Scholar18. PelzHaddad DR. Radiologic investigation of low back pain. Can Med Assoc J 1989;140:289-95. Google Scholar19. KiefferCacayorinSherry SER. The radiological diagnosis of herniated lumbar intervertebral disk. A current controversy. JAMA. 1984;251:1192-5. CrossrefMedlineGoogle Scholar20. WeiszLamondKitchener GTP. Spinal imaging: will MRI replace myelography? Spine. 1988;13:65-8. CrossrefMedlineGoogle Scholar21. ForristallMarshPay RHN. Magnetic resonance imaging and contrast CT of the lumbar spine. Comparison of diagnostic methods and correlation with surgical findings. Spine. 1988;13:1049-54. CrossrefMedlineGoogle Scholar22. . Position statement on discography [Editorial]. Spine. 1988;13:1343. Google Scholar23. Nachemson A. Lumbar discography—where are we today? [Editorial]. Spine. 1989;14:555-7. CrossrefMedlineGoogle Scholar24. NierenbergFeinstein AA. How to evaluate a diagnostic marker test. Lessons from the rise and fall of dexamethasone suppression test. JAMA. 1988;259:1699-702. CrossrefMedlineGoogle Scholar25. SchuttePark HW. The diagnostic value of bone scintigraphy in patients with low back pain. Skeletal Radiol. 1983;10:1-4. CrossrefMedlineGoogle Scholar26. GuyattTugwellFeenyHaynesDrummond GPDRM. A framework for clinical evaluation of diagnostic technologies. Can Med Assoc J. 1986;134:587-94. MedlineGoogle Scholar27. CooperChalmersMcCallyBerrierSacks LTMJH. The poor quality of early evaluations of magnetic resonance imaging. JAMA. 1988;259:3277-80. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Veterans Affairs Medical Center University of Washington School of Medicine Seattle, Washington Nextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByLow Back Pain EmergenciesDiagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; a systematic reviewLumbar spine disordersVerification of measurements of lumbar spinal dimensions in T1- and T2-weighted magnetic resonance imaging sequencesMagnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic reviewLow Back Pain EmergenciesLumbar spine disordersSpine ImagingEffects of Diagnostic Information, Per Se, on Patient Outcomes in Acute Radiculopathy and Low Back PainStepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) studyFrom the imaging department: a questionnaire study of the use of radiographs in the evaluation of spine complaintsThe Utility of Dynamic Flexion-Extension Radiographs in the Initial Evaluation of the Degenerative Lumbar SpineDiagnostic Relevance of Pressure-Controlled DiscographyAcute Low Back Pain and Radiculopathy: MR Imaging Findings and Their Prognostic Role and Effect on OutcomeDegenerative Disease and Infection: Role of ImagingEvaluation and treatment of low back pain: An evidence-based approach to clinical careEvaluating and managing acute low back pain in the primary care settingFinding cancer in primary care outpatients with low back painDisability PreventionDEGENERATIVE DISC DISEASE AND BACK PAINDegenerative diseases of the spine. 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Who You See Is What You GetClinical Assessment for Osteopenia and OsteoporosisPATHOPHYSIOLOGY AND TREATMENT OF INTERVERTEBRAL DISK DISEASEThe assessment and management of low back pain: a critical reviewLow back pain in the workplace: attainable benefits not attained.Thermography ‐ turning up the heatDiagnostic Imaging of the Lumbar SpineWilliam T. Pochis, MD, Arthur Z. Krasnow, MD, B. David Collier, MDCorrection: Diagnostic Imaging Procedures for the Lumbar SpineRichard A. Deyo, MD 1 December 1989Volume 111, Issue 11Page: 865-867KeywordsDiagnostic imagingDiagnostic radiologyHealth services researchLower back painResearch assessmentSpine Issue Published: 1 December 1989 PDF DownloadLoading ...