title: ACR Appropriateness Criteria Low Back Pain.
abstract: Most patients presenting with uncomplicated acute low back pain (LBP) and/or radiculopathy do not require imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture, and infection. Many imaging modalities are available to clinicians and radiologists for evaluating LBP. Application of these modalities depends largely on the working diagnosis, the urgency of the clinical problem, and comorbidities of the patient. When there is concern for fracture of the lumbar spine, multidetector CT is recommended. Those deemed to be interventional candidates, with LBP lasting for > 6 weeks having completed conservative management with persistent radiculopathic symptoms, may seek MRI. Patients with severe or progressive neurologic deficit on presentation and red flags should be evaluated with MRI. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
authors: Fairfax Radiology Consultants PC, Fairfax, Virginia. Electronic address: nandini416@gmail.com.
authors: Nandini D
authors: ND
authors: Patel
authors: Mayo Clinic Jacksonville, Jacksonville, Florida.
authors: Daniel F
authors: DF
authors: Broderick
authors: Montefiore Medical Center, Bronx, New York.
authors: Judah
authors: J
authors: Burns
authors: Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
authors: Tejaswini K
authors: TK
authors: Deshmukh
authors: Bone, Spine and Hand Surgery, Chartered, Brick, New Jersey, American Academy of Orthopaedic Surgeons.
authors: Ian Blair
authors: IB
authors: Fries
authors: Massachusetts General Hospital, Boston, Massachusetts.
authors: H Benjamin
authors: HB
authors: Harvey
authors: UCLA Medical Center, Los Angeles, California, neurosurgical consultant.
authors: Langston
authors: L
authors: Holly
authors: Mayo Clinic, Rochester, Minnesota.
authors: Christopher H
authors: CH
authors: Hunt
authors: University of Minnesota, Minneapolis, Minnesota.
authors: Bharathi D
authors: BD
authors: Jagadeesan
authors: University of Wisconsin Hospital and Clinic, Madison, Wisconsin.
authors: Tabassum A
authors: TA
authors: Kennedy
authors: Rush University, Chicago, Illinois, neurosurgical consultant.
authors: John E
authors: JE
authors: O'Toole
authors: Washington University School of Medicine, St Louis, Missouri, American Academy of Neurologists.
authors: Joel S
authors: JS
authors: Perlmutter
authors: University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors: Bruno
authors: B
authors: Policeni
authors: Northwestern University Feinberg School of Medicine, Chicago, Illinois, neurosurgical consultant.
authors: Joshua M
authors: JM
authors: Rosenow
authors: Walter Reed National Military Medical Center, Bethesda, Maryland.
authors: Jason W
authors: JW
authors: Schroeder
authors: Children's National Medical Center, Washington, District of Columbia.
authors: Matthew T
authors: MT
authors: Whitehead
authors: University of Cincinnati, Cincinnati, Ohio.
authors: Rebecca S
authors: RS
authors: Cornelius
authors: Emory University, Atlanta, Georgia.
authors: Amanda S
authors: AS
authors: Corey
mesh_terms: D019317:Evidence-Based Medicine; D017116:Low Back Pain / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000592:standards*; D011843:Radiculopathy / Q000000981:diagnostic imaging*; D011871:Radiology / Q000592:standards*; D012955:Societies, Medical / Q000592:standards; D014057:Tomography, X-Ray Computed / Q000592:standards*
keywords: Appropriateness Criteria; low back pain; radiculopathy; red flags