Low Back Pain

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Low back pain reportedly occurs at least once in 85% of adults  younger than 50 years, and 15-20% of Americans have at least one episode  of back pain per year. Of these patients, only 20% can be given a  precise pathoanatomic diagnosis. Low back pain affects men and women  equally. The onset most frequently occurs in people aged 30-50 years.  Low back pain is the most common and most expensive cause of  work-related disability in the United States. [3, 2] Smokers  appear to have an increased incidence of back pain compared with  nonsmokers. Furthermore, the incidence of current smoking and the  association with low back pain is higher in adolescents than in adults. 

The American College of Radiology (ACR) has published appropriateness criteria for low back pain, including the following:

• Uncomplicated acute low back pain and/or radiculopathy are benign,  self-limited conditions that do not warrant any imaging studies. 
• MRI of the lumbar spine should be considered for those patients  presenting with red flags raising suspicion for a serious underlying  condition, such as cauda equine syndrome, malignancy, or infection. 
• In patients with a history of low-velocity trauma, osteoporosis, or  chronic steroid use, initial evaluation with radiographs is  recommended. 
• In the absence of red flags, first-line treatment for chronic low  back pain remains conservative therapy with both pharmacologic and  nonpharmacologic (eg, exercise, remaining active) therapy. 
• If there are persistent or progressive symptoms during or following  6 weeks of conservative management and the patient is a surgery or  intervention candidate or diagnostic uncertainty remains, MRI of the  lumbar spine has become the initial imaging modality of choice in  evaluating complicated low back pain. 
• MRI is the imaging procedure of choice in patients suspected of cord compression or spinal cord injury. 
• Patients with recurrent low back pain and history of prior surgical intervention should be evaluated with contrast-enhanced MRI. 

Thanks

Author  

Sherman Tran MD

 Founder and President, Spine & Sports Medical Group