title: Spine radiography in the evaluation of back and neck pain in an orthopaedic emergency clinic.
abstract: OBJECTIVE
  Despite the recommendations of national and international societies for the treatment of patients with acute neck and back pain, still too many radiologic examinations were performed. The purpose of this study was to analyze and optimize diagnostics and treatment of patients with acute back pain.
  
  
  METHODS
  The medical records of 484 patients presented to the emergency clinic with acute neck or back pain were analyzed for clinical history, physical examination, radiographic findings and therapy.
  
  
  RESULTS
  Radiographs of the lumbar, cervical, or thoracic spine were performed in 338 cases (70%). Radiographs were normal in 142 patients (42%) and degenerative changes were identified in 123 patients (36%). Only 2 patients (0.4%) had radiographic findings that had direct therapeutic relevance: 1 patient with metastatic disease and 1 patient with posttraumatic C1-C2 instability. For most patients without sensorimotor deficits and absent specific indications for radiography (“red flags”), therapy was not affected by the results of radiography.
  
  
  CONCLUSIONS
  Plain radiography of the spine was unnecessary in most patients initially evaluated with non-specific acute back pain and does not improve the clinical outcome. The implementation of national and international guidelines is a slow process, but helps to reduce costs and to protect patients from unnecessary ionizing radiation exposure.
authors: Ulf Gunther
authors: UG
authors: Leichtle
authors: Markus
authors: M
authors: Wünschel
authors: Marianna
authors: M
authors: Socci
authors: Christophe
authors: C
authors: Kurze
authors: Thomas
authors: T
authors: Niemeyer
authors: Carmen Ina
authors: CI
authors: Leichtle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000000981:diagnostic imaging*; D002648:Child; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008161:Lumbosacral Region / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000000981:diagnostic imaging*; D009985:Orthopedics; D011859:Radiography; D013131:Spine / Q000000981:diagnostic imaging*; D019564:Unnecessary Procedures; D055815:Young Adult