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