Back Pain and the Radiologist

The exact role of the radiologist in assessing patients with low back pain remains vague, which is in keeping with this syndrome's uncertain etiology and controversial therapy. Conventional radiographs of the lumbosacral spine have a limited role in most such patients, primarily in excluding neoplasm, infection, or ankylosing spondylitis. This examination can ordinarily be limited to two views; and, for radiation and economic reasons, radiographs should usually be initially deferred in young patients and/or those with acute symptoms. Symptoms will abate in most of these patients, making radiological examination unnecessary. Computed tomography (CT) is the method of choice in the diagnosis of spinal stenosis and possibly herniated nucleus pulposus and facet joint abnormalities as well. Preliminary data showing symptomatic relief of pain following facet joint injection could open an entire new area of interventional radiology. Confirmatory studies are needed in this exciting and potentially important area of investigation.