When Is Imaging Appropriate for a Patient With Low Back Pain?

Lancaster, Brian L.; Goldman, Joshua; Kobayashi, Yohnosuke; Gottschalk, Andrew W.

doi:10.31486/toj.20.0077

Cited by 2 publications

(4 citation statements)

References 6 publications

(20 reference statements)

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“…In this case, the fact that the patient presented pain at rest, without improvement with conservative care and motivating several visits to the emergency department for continued complaint should have raised concern for serious pathology and lead to earlier investigation. Only after the development of major red flags, such as neurologic compromise and fever, imaging exams were requested and diagnosis of SEA was reached [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, in rare cases, acute spinal pain can be caused by serious underlying diseases and the identification of these cases is challenging and demanding. A comprehensive evaluation looking for red-flag signs and symptoms remains a cornerstone on the evaluation of acute spinal pain [ 2 ]. We present a case of a very rare pathology as the cause of a very common presentation in the emergency setting.…”

Section: Introductionmentioning

confidence: 99%

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Epidural Abscess: A Cause of Back Pain That Must Not Be Missed

Sousa

Monteiro

Piteira

et al. 2021

Cureus

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Low back and cervical pain are common emergency department complaints. Most cases represent low-risk pathologies but in rare cases, it can be a symptom of a serious underlying disease and the distinction can be challenging. A case is reported of a 58-year-old male with recurrent cervical pain requiring several emergency department visits. He eventually presented with intense cervical and low back pain, tetraparesis, and dyspnea. His condition deteriorated in less than 24 hours, evolving with fever, shock, and respiratory insufficiency and was admitted to the Intensive Care Unit for aminergic support, invasive mechanical ventilation and started on empiric antibiotics. Investigations revealed raised inflammatory markers and a cervical pre-vertebral purulent collection associated with an epidural collection at the level of C2 to C5 with spinal cord compression. The patient underwent transoral drainage and removal of the posterior C1 arch along with C2-C3-C4-C5 laminectomy. Staphylococcus aureus was isolated in the blood, pus, and bone. Reintervention was required due to persistent pre-vertebral abscesses with clinical improvement thereafter. Eight weeks of antibiotic treatment were completed in total. The patient was discharged after 72 days of hospitalization with significant improvement in force and autonomy. Epidural abscess is a rare finding that can cause rapid irreversible neurological deterioration. Clinical suspicion must be high for an early diagnosis and treatment, essential for a better prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Epidural Abscess: A Cause of Back Pain That Must Not Be Missed

Sousa

Monteiro

Piteira

et al. 2021

Cureus

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“…Google search #1: "low back pain x-ray" Google search #2: "imaging for lower back pain" TABLE 1: Websites utilized for readability analysis for two different search queries: "low back pain x-ray" and "imaging for low back pain." 1 Website excluded due to accessibility requiring payment (specifically, an UpToDate).…”

Section: Position In Querymentioning

confidence: 99%

“…When determining the etiology of a patient's acute lower back pain (LBP), a physician may or may not choose to order radiographic imaging. The necessity to incorporate imaging in the initial assessment of LBP depends on a variety of factors, such as the duration of pain, presence of red-flag symptoms, patient age, history of trauma, and prior history of back pain [1]. However, for patients experiencing acute LBP -defined as pain persisting for less than four weeks -without any accompanying symptoms, the utility of obtaining imaging is considered quite low and has been associated with increased invasive procedures and health care costs [2].…”

Section: Introductionmentioning

confidence: 99%

Lower Back Pain Imaging: A Readability Analysis

Valentine,

Cottone,

Kramer

et al. 2023

Cureus

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Purpose: The internet provides access to a myriad of educational health-related resources which are an invaluable source of information for patients. Lower back pain is a common complaint that is discussed extensively online. In this article, we aim to determine if the most commonly accessed articles about lower back pain imaging use language that can be understood by most patients. According to the American Medical Association (AMA) and National Institute of Health (NIH), this corresponds to a sixth-grade reading level.Methods: Online searches were conducted from the most commonly used search engine, Google, to assess the present state of readability on radiograph imaging for LBP. Then the top 20 populated URL links from each search were utilized based on "health & fitness" search trends and click-through rates (CTRs). The readability of various websites was evaluated with WebFX online software that analyzed the unique websites' text when put into reader view on Firefox web browser version 116.0.3 (64-bit). Evaluation occurred via five common readability indices: the Automated Readability Index (ARI), the Coleman Liau Index (CLI), the SMOG index, the Gunning Fog Score Index (GFSI), and the Flesch Kincaid Grade Level Index (FKGLI). In addition, the Flesch Kincaid Reading Ease Index (FKREI) was also used but was excluded from the calculation due to its measuring scale outside of US grade levels. The number of samples was analyzed via health and fitness-specific CTR from an open-access database from July 2022 to July 2023. This was used to calculate the number of persons clicking and visiting positional URLs (first URL to the 20th URL) from each unique keyword search and the rational criteria for selecting the first 20 websites for each query.Results: Online material that included LBP imaging information was calculated to have an overall readability score of 10.745 out of the 23 websites obtained from unique searches. The range was a mean readability score of 8 to 14. Notably, 17 websites were excluded from a total of 40 websites due to duplication of the same data (URLs that resulted from both unique searches) and accessibility requiring payment (specifically, an UpToDate link). A readability score of 10.745 refers to an 11th-grade reading level. That is to say, the most commonly visited sites on Google that contain information about lower back pain imaging are, on average, five grade levels higher than the sixth-grade reading level recommended by the AMA and the NIH.Conclusions: Most internet content regarding lower back pain imaging is written at a reading level that is above the recommended limit defined by the AMA and NIH. To improve education about lower back pain imaging and the patient-physician relationship, we recommend guiding patients to online material that contains a reading level at the sixth-grade level as suggested by the AMA and NIH.

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When Is Imaging Appropriate for a Patient With Low Back Pain?

Cited by 2 publications

References 6 publications

Epidural Abscess: A Cause of Back Pain That Must Not Be Missed

Epidural Abscess: A Cause of Back Pain That Must Not Be Missed

Lower Back Pain Imaging: A Readability Analysis

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