Level 2: Mid-level evidence

Although lumbar imaging for acute low back pain is generally indicated only if there is concern for serious underlying disease (e.g., infection, malignancy), many physicians continue to order imaging studies on a routine basis for these patients. In support of previous research, a recent systematic review of six randomized trials evaluating immediate radiography, MRI, or CT in 1,804 patients (without markers for serious underlying disease) showed no benefit for this practice in either short-term (less than three months) or long-term (6-12 months) follow-up. There were no significant differences between immediate imaging and standard care in pain, function, quality of life, mental health, or overall improvement (Lancet. 2009;373:463-472).