ACR Appropriateness Criteria Low Back Pain

Nandini D. Patel, Daniel F. Broderick, Judah Burns, Tejaswini K. Deshmukh, Ian Blair Fries, H. Benjamin Harvey, Langston Holly, Christopher H. Hunt, Bharathi D. Jagadeesan, Tabassum A. Kennedy, John E. O'Toole, Joel S. Perlmutter, Bruno Policeni, Joshua M. Rosenow, Jason W. Schroeder, Matthew T. Whitehead, Rebecca S. Cornelius, Amanda S. Corey

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Most patients presenting with uncomplicated acute low back pain (LBP) and/or radiculopathy do not require imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture, and infection. Many imaging modalities are available to clinicians and radiologists for evaluating LBP. Application of these modalities depends largely on the working diagnosis, the urgency of the clinical problem, and comorbidities of the patient. When there is concern for fracture of the lumbar spine, multidetector CT is recommended. Those deemed to be interventional candidates, with LBP lasting for > 6 weeks having completed conservative management with persistent radiculopathic symptoms, may seek MRI. Patients with severe or progressive neurologic deficit on presentation and red flags should be evaluated with MRI. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Original languageEnglish (US)
Pages (from-to)1069-1078
Number of pages10
JournalJournal of the American College of Radiology
Volume13
Issue number9
DOIs
StatePublished - Sep 1 2016

Fingerprint

Low Back Pain
Guidelines
Polyradiculopathy
Radiculopathy
Expert Testimony
Back Pain
Neurologic Manifestations
Comorbidity
Spine
Therapeutics
Infection
Neoplasms

Keywords

  • Appropriateness Criteria
  • low back pain
  • radiculopathy
  • red flags

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Patel, N. D., Broderick, D. F., Burns, J., Deshmukh, T. K., Fries, I. B., Harvey, H. B., ... Corey, A. S. (2016). ACR Appropriateness Criteria Low Back Pain. Journal of the American College of Radiology, 13(9), 1069-1078. https://doi.org/10.1016/j.jacr.2016.06.008

ACR Appropriateness Criteria Low Back Pain. / Patel, Nandini D.; Broderick, Daniel F.; Burns, Judah; Deshmukh, Tejaswini K.; Fries, Ian Blair; Harvey, H. Benjamin; Holly, Langston; Hunt, Christopher H.; Jagadeesan, Bharathi D.; Kennedy, Tabassum A.; O'Toole, John E.; Perlmutter, Joel S.; Policeni, Bruno; Rosenow, Joshua M.; Schroeder, Jason W.; Whitehead, Matthew T.; Cornelius, Rebecca S.; Corey, Amanda S.

In: Journal of the American College of Radiology, Vol. 13, No. 9, 01.09.2016, p. 1069-1078.

Research output: Contribution to journalArticle

Patel, ND, Broderick, DF, Burns, J, Deshmukh, TK, Fries, IB, Harvey, HB, Holly, L, Hunt, CH, Jagadeesan, BD, Kennedy, TA, O'Toole, JE, Perlmutter, JS, Policeni, B, Rosenow, JM, Schroeder, JW, Whitehead, MT, Cornelius, RS & Corey, AS 2016, 'ACR Appropriateness Criteria Low Back Pain', Journal of the American College of Radiology, vol. 13, no. 9, pp. 1069-1078. https://doi.org/10.1016/j.jacr.2016.06.008
Patel ND, Broderick DF, Burns J, Deshmukh TK, Fries IB, Harvey HB et al. ACR Appropriateness Criteria Low Back Pain. Journal of the American College of Radiology. 2016 Sep 1;13(9):1069-1078. https://doi.org/10.1016/j.jacr.2016.06.008
Patel, Nandini D. ; Broderick, Daniel F. ; Burns, Judah ; Deshmukh, Tejaswini K. ; Fries, Ian Blair ; Harvey, H. Benjamin ; Holly, Langston ; Hunt, Christopher H. ; Jagadeesan, Bharathi D. ; Kennedy, Tabassum A. ; O'Toole, John E. ; Perlmutter, Joel S. ; Policeni, Bruno ; Rosenow, Joshua M. ; Schroeder, Jason W. ; Whitehead, Matthew T. ; Cornelius, Rebecca S. ; Corey, Amanda S. / ACR Appropriateness Criteria Low Back Pain. In: Journal of the American College of Radiology. 2016 ; Vol. 13, No. 9. pp. 1069-1078.
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