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Review: clinical findings should determine choice of imaging test for patients with low back pain in a primary care setting

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 QUESTION: In patients with low back pain in a primary care setting, what is the diagnostic accuracy of clinical information and imaging?

Data sources

Studies were identified by searching Medline (January 1966 to September 2001).

Study selection

Studies were selected if they described the accuracy of plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), or bone scanning in patients with low back pain. Paediatric studies and studies of myelography, discography, and positron emission tomography were excluded.

Data extraction

Extracted data included diagnostic results and methodological quality.

Main results

73 studies were included. The estimated diagnostic accuracy of plain radiography, CT, and MRI for herniated disc and cancer are displayed in the table. For vertebral metastatic lesions, plain radiography was less sensitive than other imaging tests. In primary care patients, the presence of a lytic or blastic lesion on plain radiographs had a sensitivity of 60% and a specificity of 99.5% for cancer. For vertebral infection, radiography had low specificity; in …

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  • For correspondence: Dr J G Jarvik, University of Washington, Seattle, WA, USA.jarvikj{at}

  • Sources of funding: Agency for Healthcare Research and Quality and National Institute of Arthritis and Musculoskeletal and Skin Diseases.