International guidelines 2 and “Choosing Wisely” campaigns now encourage a diagnostic triage approach to identify those patients who require imaging ( box 1). 1 For the remaining 90-95% of LBP cases (called non-specific or uncomplicated LBP), imaging will not guide management and can cause more harm than benefit. These conditions include cancer, infection, inflammatory disease, fracture, and severe neurological deficits-which together account for only 5-10% of LBP presentations in primary care. Evidence now indicates that imaging is useful only in the small subgroup of patients for whom there is suspicion of red flag conditions. Imaging was once a routine part of the diagnostic workup for most cases of LBP. The past two decades have seen a paradigm shift in the way we use imaging when managing low back pain (LBP).
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