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January 1989

Plain Roentgenography for Low-Back Pain: Finding Needles in a Haystack

Author Affiliations

Northwest Health Services Research and Development Field Program Seattle Veterans Administration Medical Center (152) 1660 S Columbian Way Seattle, WA 98108

Arch Intern Med. 1989;149(1):27-29. doi:10.1001/archinte.1989.00390010045002

Back pain is a pervasively common problem, one often considered part of the orthopedic surgeon's domain. However, this patient complaint is common in the offices of internists1 and rheumatologists2 as well and rarely requires surgery. Some authors assert that plain roentgenography is part of the "minimal evaluation" for all patients with low-back pain. For a variety of reasons, however, there is a growing consensus that lumbar spine roentgenography should be limited to See also p 47. carefully selected patients3-5 and a small number of views.4,6,7 The value of plain films is restricted by a low yield of findings that alter therapy,8 a poor association between roentgenographic findings and patient symptoms, 8,9 failure to reveal important lesions that clearly cause pain (eg, herniated disks), substantial gonadal irradiation, 10 frequent disagreements in interpretation, 11 and large aggregate costs.

Perhaps because of conflicting expert recommendations in the past,

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