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Diagnostic Imaging for Spinal Pain

Imaging equipment in use today can create “pictures” of not only bones but also organs and soft tissue. These kinds of pictures, or images, can help diagnose an illness or injury. Diagnostic imaging can be confusing, however. The pictures may show information such as minor abnormal conditions. This information is not always helpful to a provider deciding how to treat spinal pain. When newer imaging (CT and MRI) has been used more, providers will know what kind of problems imaging will help. 

Your Allina Medical Clinic health care provider will follow established guidelines related to ordering diagnostic imaging tests for spinal pain. An Adult Spinal Pain Task Force within Allina Medical Clinic developed these guidelines. They reflect the best practice (the best way) to treat spinal pain known today. The guidelines address: 

• When imaging tests are normally not needed
  • during the first four weeks of treatment if your medical history and a physical exam do not raise any “red flags.” Red flags are signs or symptoms that you may have a serious health condition besides a back problem. (See the list of red flags below.) During the first four weeks of treatment, 90 percent of spinal pain patients recover, avoiding unneeded procedures and charges for them.
  • during the first eight weeks of treatment if you are a worker’s compensation patient and your medical history and physical exam do not raise any red flags
  • if you have chronic spinal pain but no red flag signs or symptoms 
  • if you have chronic pain that has not responded to aggressive treatment but no red flag signs or symptoms
  • if you are younger than age 20 and your medical history and physical exam do not raise any red flag signs or symptoms.

• When imaging tests may be considered
  • if you have red flag signs or symptoms. The main red flags are:
    • a recent serious trauma
    • a recent mild trauma if you are over age 70
    • a recent mild trauma if you have either used steriods for a long time or are at risk for osteoporosis
    • a personal history of cancer
    • a fever higher than 100 degrees Fahrenheit
    • IV (intravenous) drug use
    • spinal pain worse with rest
    • unexplained weight loss.
    If you have any of the above, your provider may order plain imaging, such as an X-ray, early in your course of treatment. 
• if you are younger than age 20 and do not respond quickly to treatment or your condition gets worse
• if you have chronic spinal pain and your quality of life is poor enough that you have agreed to have surgery if imaging shows a need for it
• if you have a herniated disc not helped by treatment and you have agreed to have surgery if imaging shows a need for it.

If you are younger than age 20, your provider will also consider the following before ordering any diagnostic imaging for spinal pain:

• congenital or developmental problems
• secondary causes of spinal pain.

If your provider does intend to order some kind of diagnostic imaging, he or she may consult with a radiologist or other specialist to determine the best kind of imaging. You may be scheduled for an X-ray, CT scan, MRI or bone scan.