Review: Immediate routine lumbar-spine imaging does not improve clinical outcomes in low-back pain

In patients with low-back pain and no serious underlying condition, does immediate routine lumbar-spine imaging improve clinical outcomes more than usual care without immediate imaging?

Included studies compared immediate routine lumbar imaging with usual clinical care without immediate imaging in patients with low-back pain (acute or chronic) and without indications of serious underlying conditions. Outcomes were change in scores for pain, function, mental health, and quality of life.

MEDLINE (Aug 2008), Cochrane Central Register of Controlled Trials (Issue 3, 2008), and references were searched for randomized controlled trials (RCTs). 6 RCTs (n = 1804) met the selection criteria. 4 trials reported adequate concealment of allocation, and 1 trial had blinded outcome assessment. The imaging method used was radiography in 4 RCTs and magnetic resonance imaging (MRI) or computed tomography (CT) in 2 RCTs. Duration of follow-up ranged from 3 weeks to 2 years.

Groups did not differ for short-term (≤ 3 mo) or long-term (6 to 12 mo) clinical outcomes (Table). Immediate imaging did not increase the proportion of patients with subjective overall improvement in the short term (relative risk [RR] 0.83, 95% CI 0.65 to 1.06; 4 RCTs, n = 731) or long term (RR 0.82, CI 0.64 to 1.05; 1 RCT n = 394).

In patients with low-back pain and no serious underlying condition, immediate routine lumbar-spine imaging does not improve clinical outcomes more than usual care without immediate imaging.