Evidence-based recommendations for spine surgery

Alexander R. Vaccaro, Charles G. Fisher, Peter G. Whang, Alpesh A. Patel, Srinivas K. Prasad, Peter D. Angevine, Kishore Mulpari, Ken C. Thomas

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


Lumbar spinal imaging is commonly utilized in the evaluation of low back pain. The rationale for imaging, either plain radiographs, computed tomography (CT), or magnetic resonance imaging (MRI), is primarily based on identifying anatomical sources of pain. Unfortunately, the correlation between findings on imaging and clinical symptoms can be limited. A number of studies have been preformed to elucidate the value of spinal imaging in the setting of acute back pain. The definition of "value", however, varies from study to study. Investigations have focused separately on diagnostic information, treatment interventions, patient outcomes, or patient satisfaction. Additionally, the inclusion and exclusion criteria for these studies have not been uniform. Specifically the definition of "red flags" for serious disease (fevers, weight loss, neurological deficits, etc.) are subjective and, in some instances, not defined. Nonetheless the clinical question remains: is immediate routine lumbar spine imaging more effective than usual care without imaging in patients with low back pain and no suggestion of "red flags." Chou et al. used methods ofsystematic review and meta-analysis to address this question.

Original languageEnglish (US)
Pages (from-to)E178-E188
Issue number6
StatePublished - Mar 15 2010

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology


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