Clinical condition—Low back pain

MRI (lumbar spine, without contrast)MRI (lumbar spine, without and with contrast)CT (lumbar spine, without contrast)CT (lumbar spine, without and with contrast)X-ray (lumbar spine)CT MyelogramMyelogramBone scan
Uncomplicated, no red flags222N/A22a2a2
Low velocity trauma, osteoporosis, and/or age >70836bN/A61a1a4
Suspicion of cancer, infection or immunosuppression874N/A52a2a5
Prior lumbar surgery68c6bN/A5d5a2a5
Cauda equina syndrome9e8eN/A4b,e36a,b2a2
  • Note:—Appropriateness criteria scale from 1 to 9, 1 = least appropriate, 9 = most appropriate;

  • a , indicates CT and myelography often combined;

  • b , useful if MRI contraindicated or nondiagnostic;

  • c , differentiate disk versus scar;

  • d , flex/extension may be useful;

  • e , use of contrast depends on clinical circumstances