Low Back Pain

American Journal of Neuroradiology

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 Myelogram	Myelogram	Bone scan
Uncomplicated, no red flags	2	2	2	N/A	2	2^a	2^a	2
Low velocity trauma, osteoporosis, and/or age >70	8	3	6^b	N/A	6	1^a	1^a	4
Suspicion of cancer, infection or immunosuppression	8	7	4	N/A	5	2^a	2^a	5
Radiculopathy	8	5^b	5	N/A	3	5^a,^b	2^a	2
Prior lumbar surgery	6	8^c	6^b	N/A	5^d	5^a	2^a	5
Cauda equina syndrome	9^e	8^e	N/A	4^b,^e	3	6^a,^b	2^a	2

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