A review of utilization of diagnostic imaging in the evaluation of patients with back pain: The when and what of back pain imaging

Abstract

Purpose: To review the indications for imaging in patients with back pain. Methods: The author's experience as a clinical neuroradiologist in dealing with both referring physicians and their patients with back pain form the basis of this manuscript. Several texts and recent peer reviewed papers dealing with imaging of the spine were consulted. Results: There are controversies over when to image and the appropriate imaging modality to be used. The author presents his views on the sources of these controversies and his philosophy on imaging patients with back pain. A brief review of the major imaging findings in degenerative and non-degenerative causes of back pain is presented. To fully appreciate and see examples of these imaging findings, the reader should read texts devoted to spinal imaging. Conclusion: Controversy over the decision of when to perform imaging of patients with back pain persist. From the perspective of the radiologist there is little controversy over the choice of imaging studies to be performed. MRI is superior to all other tests in the identification of degenerative and non-degenerative causes of back pain. CT without intrathecal contrast is an excellent test for degenerative disease but will often fail to detect non-degenerative (e.g. neoplastic) causes of back pain.