Because back pain is the second leading cause of work absenteeism and the number one cause of Workers’ Compensation claims, it is important to understand the appropriate role of radiologic imaging in the assessment of spinal dysfunction. The goal of any imaging study is to define accurately the path morphologic changes in a specific tissue, organ, or part of the body. Objective categorization of pathologic changes facilitates the interpretation and communication of abnormalities detected on a test, and these same criteria can be used on follow-up evaluation to assess the effects of different forms of therapy (eg, surgical intervention or non-operative rehabilitation). The reproducibility and the reliability of all objective diagnostic criteria must be rigorously evaluated in prospective blinded studies prior to their implementation.
Patients with neck or low-back pain (LBP) are a challenge to the physician who desires a precise patho-anatomic diagnosis prior to the initiation of therapy. Back pain and neural dysfunction are a frequent symptom complex for many processes afflicting the lumbar spine and Paraspinal tissues. For this reason, a clinical assessing a patient after a work-related injury must consider and exclude a large number of potential causes to explain a patient’s symptoms. Fortunately, most episodes of back pain are self-limited, and diagnostic tests are needed. However, if pain persists or becomes worse, it is usually necessary to order a diagnostic test to provide the additional clinical information needed to choose rationally the appropriate therapeutic modality. Prior to ordering any diagnostic test, a clinician must determine how the information provided by the test will affect patient management and mentally compare projected test costs and expected benefits. The more precise the information provided by a diagnostic test, the greater will be its impact on directing patient care. The value of different tests depends on their sensitivity, specificity, accuracy, risk, cost, and availability.