Imaging For Back Pain

The Rotherham NHS Foundation Trust
Department of Clinical Radiology
Imaging For Back Pain
An audit of Practice
Non-specific back pain is a common problem for primary and secondary care. It is
defined as back pain lasting longer than 6 weeks and less than 12 months with no
specific cause suspected such as a fracture, infection, malignancy or inflammatory
Back pain is a major cause of sickness and absence from work.
A large number of lumbar spine x-rays are undertaken for back pain which results in a
significant contribution to the radiation burden of the population. The radiation dose
of a simple single lateral spine x-ray is the equivalent to 50 chest x-rays.
In 2007 the Royal College of Radiologists issues guidelines for imaging non-specific
back pain saying “x-rays only indicated if presentation suggests osteoporotic collapse
in the elderly for suspected spondylo-arthropathies in young patients”.
NICE Guidelines (CG88; 2009) state “Do not offer x-ray of the lumbar spine for the
management of non-specific low back pain. However, the guidelines concede that
patients gain satisfaction from having information needs met by the x-ray. NICE
guidelines state that MRI should be considered when a diagnosis of spinal
malignancy, infection, fracture, cauda equina syndrome, ankylosing spondylitis or
another inflammatory disorder is suspected.
An audit was undertaken to evaluate the appropriateness of a lumbar spine
radiography request for non specific back pain with reference to the above guidelines.
50 examinations requested by GP’s were sampled at random. The results
demonstrated only 22% of lumbar spine radiographs undertaken met either the
2007 RCR guidelines or the 2009 NICE guidelines.
I hope you find the above information useful. A reduction in unnecessary x-rays is
desirable as this reduces costs and the radiation burden.
Paul Spencer
Clinical Director and Consultant Radiologist