Guidelines for Imaging Cervical and Thoracic and Lumbar
Spine
Cervical Spine
Neck pain
Red Flag Symptoms
Reduced range of movement cervical spine
Duration more than three months or recent significant trauma
Tenderness on palpation, resting muscle spasm
No improvement with appropriate physiotherapy
May have radicular symptoms in the upper limbs
Clinical Impression
1. Suspected degenerative changes in the cervical spine
2. Suspicion of sinister pathology
3. Nerve Root Entrapment (but generally MRI investigation of choice)
4. Suspected Fracture
X-Ray Required
1 & 2 & 3. Lateral Cervical Spine
3. AP and Lateral Cervical Spine
Thoracic Spine
Thoracic Pain
Red Flag Symptoms
Reduced range of movement thoracic spine
Duration more than three months or recent significant trauma
Increased fracture risk ie risk of osteoporosis
Tenderness on palpation, resting muscle spasm
May have radiating pain around the rib cage
May have scoliosis/increased kyphosis
Clinical Impression
1. Suspected scoliosis
2. Suspected degenerative changes in the thoracic spine
3. Suspicion of sinister pathology
4. Suspected fracture
X-Ray Required
1. AP whole spine for scoliosis
2 & 3 & 4. AP and Lateral Thoracic Spine
NHSG March 2012
Lumbar Spine
Back pain
Red Flag Symptoms
Reduced range of movement lumbar spine
Duration more than three months or recent significant trauma
Tenderness on palpation, resting muscle spasm
No improvement with appropriate physiotherapy
May have radicular symptoms in the lower limbs
Clinical Impression
1. Suspected degenerative changes in the lumbar spine
2. Nerve Root Entrapment (but generally MRI investigation of choice)
3. Suspected spinal stenosis
4. Suspected fracture
5. Suspicion of sinister pathology
6. Mechanical pain without recent trauma or red flags between the ages of 20
and 55
7. Spondylolythesis
X-Ray Required
1 & 2 & 3 & 4 & 5. AP and Lateral Lumbar Spine possibly in weight bearing
6. Lateral Lumbar spine
7. Oblique views if clinical and radiological suspicion of pars defect at the
suggestion of the radiologist in their report.
MRI
1. Radicular pain not resolving after three months of appropriate
conservative management.
2. Clinical and radiological suspicion of spinal stenosis
3. Suspected sinister pathology
4. Exclude sinister pathology in an anxious patient who has not improved
with extensive conservative management
NHSG March 2012