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Lumbar Spine

 

Lumbar spine x-ray involves a relatively high dose of ionising radiation. With this in mind the following guidance has been developed.

 

RCHT radiology will accept requests from GP’s for lumbar spine x-ray’s in patients aged over 16 years old with new onset back pain in the absence of red flags for the following indications:

  • Exclusion of vertebral fracture in individuals with suspected or established osteoporosis, or following a history of trauma
  • Suspected bony malignancy
  • In the context of previous spinal surgery - including vertebroplasty, or spinal surgery with metalwork in situ; such as instrumented spinal fusion, scoliosis correction, or pars fixation

 

Red Flags

Suspected osteomyelitis, discitis or spinal abscess should be referred through the acute GP service

Acute significant spinal trauma should be referred through the emergency department

 

 

Suspected ankylosing spondylitis or inflammatory spondyloarthropathy

GP requests for spinal imaging in these patients will be rejected as per NICE guidance and are not necessary prior to referral. Rheumatology will arrange appropriate imaging if needed

Rheumatology guidance for suspected inflammatory back pain is available here

 

Patients under 16 years old

Lumbar spine x-ray requests will be rejected

Please refer to the paediatric back pain guidance here

 

For lumbar spine x-ray requests not meeting the above criteria please direct enquiries to the radiology advice and guidance email service:

rch-tr.GPRadiologyEnquiries@nhs.net

 

 

Date reviewed               25/02/2020

Next review due            25/02/2021

Sifter name                   Dr Joseph Rintoul  RMS GP Lead Imaging

 

Version No.                   1.0

 

Contributors

 

Dr Kim Farmer, Consultant Radiologist, RCHT

Mr Andrew Clarke, Consultant Paediatric and Adult Spine Surgeon, Princess Elizabeth Orthopaedic Centre

Dr Sham Agashi, Community Sub-Dean, University of Exeter Medical School

 

 

References

 

NICE:Low back pain and sciatica in over 16s: assessment and management

https://www.nice.org.uk/guidance/ng59/

 

NICE: Spondyloarthritis in over 16s: diagnosis and management

https://www.nice.org.uk/guidance/ng65

 

NICE: Back pain – low (without radiculopathy)

https://cks.nice.org.uk/back-pain-low-without-radiculopathy

 

NICE CKS: Ankylosing spondylitis

https://cks.nice.org.uk/ankylosing-spondylitis

 

F Wall, B & Haylock, R & T M Jansen, J & C Hillier, M & Hart, D & C Shrimpton, P. (2011). Radiation Risks from Medical X-ray Examinations as a Function of the Age and Sex of the Patient. Centre for Radiation, Chemical and Environmental Hazards, Health Protection Agency