Abstract • For patients visiting a primary care office practice for acute low back pain, we compared the benefits, risks, and costs of obtaining a roentgenogram of the lumbar spine routinely at the initial visit with performing a roentgenogram only if the patient's pain does not improve during an eight-week follow-up period. The cost-effectiveness analysis indicated that, to avert one day of physical suffering in a population of patients, the population would have to be subjected to the additional risk of 3,188 mrad of radiation and an additional cost of $2,072. While, in the individual case, circumstances might lead to a different conclusion, in general, the risks and costs of obtaining lumbar roentgenograms at the initial visit in patients with acute low back pain do not seem to justify the relatively small associated benefit. (Arch Intern Med 1982;142:1108-1112) References 1. The National Ambulatory Medical Care Survey: Office Visits to Internists, United States, 1975 , publication 79-1787. US Dept of Health, Education, and Welfare, 1978. 2. Kelsey JL, White AA: Epidemiology and impact of low back pain. Spine 1980;5:133-142.Crossref 3. Akeson WH, Murphy RW: Low back pain. Clin Orthop 1977;129:2-3.Crossref 4. Rockey PH, Tompkins RK, Wood RW, et al: The usefulness of X-ray examinations in the evaluation of patients with back pain. J Fam Pract 1978;7:455-465. 5. Scavone JG, Latshaw RF, Rohrer GV: Use of lumbar spine films: Statistical evaluation at a university teaching hospital. JAMA 1981; 246:1105-1108.Crossref 6. The National Ambulatory Medical Care Survey: Office Visits Involving X-Rays, United States, 1977 , publication 79-1250. US Dept of Health, Education, and Welfare, 1979. 7. Connors JP: Summary remarks by Gitlin J , in Summary Report and Proceedings of the Conference on Low Back X-rays in Preemployment Physical Examinations . Tuscon, American College of Radiology, 1973. 8. Baker AS, Ojemann RG, Swartz MN, et al: Spinal epidural abscess. N Engl J Med 1975;293:463-468.Crossref 9. Barton JE, Haight RO, Marsland DW, et al: Low back pain in the primary care setting. J Fam Pract 1976;3:363-366. 10. Dillane JB, Fry J, Kalton G: Acute back syndrome—a study from general practice. Br Med J 1966;2:82-84.Crossref 11. Rowe ML: Low back pain in industry, a position paper. J Occup Med 1969;11:161-169.Crossref 12. Huvos AG: Bone Tumors: Diagnosis, Treatment, & Prognosis . Philadelphia, WB Saunders Co, 1979. 13. Dahlin DC: Bone Tumors , ed 3. Springfield, Ill, Charles C Thomas Publisher, 1978. 14. Antoku S, Russell WJ: Dose to the active bone marrow, gonads, and skin from roentgenography and fluoroscopy. Radiology 1971;101:669-678.Crossref 15. Raiffa H: Decision Analysis . Reading, Mass, Addison-Wesley Publishing Co Inc, 1970. 16. Horal J: The clinical appearance of low back disorders in the city of Gothenburg, Sweden: Comparisons of incapacited probands with matched controls. Acta Orthop Scand Suppl 1969;118:1-109. 17. Fullenlove TM, Williams AJ: Comparative roentgen findings in symptomatic and asymptomatic backs. Radiology 1957;68:572-574.Crossref 18. Hussar AE, Guller EJ: Correlation of pain and the roentgenographic findings of spondylosis of the cervical and lumbar spine. Am J Med Sci 1956;232:518-527.Crossref 19. Magora A, Schwartz A: Relation between the low back pain syndrome and x-ray findings: I. Degenerative findings. Scand J Rehabil Med 1976;8:115-126. 20. Magora A, Schwartz A: Relation between the low back pain syndrome and x-ray findings. II. Transitional vertebra (mainly sacralization). Scand J Rehabil Med 1978;10:135-145. 21. Splithoff CA: Lumbosacral junction: Roentgenographic comparison of patients with and without backache. JAMA 1953;152:1610-1613.Crossref 22. Torgerson WR, Dotter WE: Comparative roentgenographic study of the asymptomatic and symptomatic lumbar spine. J Bone Joint Surg Am 1976;58:850-853. 23. National Academy of Sciences National Research Council: The Effects on Population of Exposure to Low Levels of Ionizing Radiation . Washington, DC, National Academy of Sciences, 1972, p 91.
Archives of Internal Medicine – American Medical Association
Published: Jun 1, 1982