Guidelines

Special Studies - Plain X-Rays - Panel

	Findings and Recommendations	Strength of Evidence
1.	Plain x-rays are not recommended for routine evaluation of patients with acute low back problems unless a red flag is noted on clinical examination (such as specified below).	B
2.	Plain x-rays of the lumbar spine are recommended for ruling out fractures in patients with acute low back problems when any of the following red flags are present: recent significant trauma (any age), recent mild trauma (patient over age 50), history of prolonged steroid use; osteoporosis; patient over age 70.	C
3.	Plain x-rays in combination with CBC and ESR may be useful for ruling out tumour or infection in patients with acute LBP when any of the following red flags are present: prior cancer or recent infection, fever >100 F, IV drug abuse, prolonged steroid use, low back pain worse with rest, unexplained weight loss.	C
4.	In the presence of red flags, especially for tumor or infection, the use of other imaging studies, such as bone scan, CT, or MRI, may be clinically indicated even if plain x-rays are negative.	C
5.	The routine use of oblique lumbar x-rays is not recommended for adults in light of the increased radiation exposure.	B