SynthesisEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2019
Imaging versus no imaging for low back pain: a systematic review, measuring costs, healthcare utilization and absence from work.
Synthesis in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
53 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Models of care for managing non-specific low back pain.The Cochrane database of systematic reviews · 2025Pooled it
- Audit and feedback to change diagnostic image ordering practices: A systematic review and meta-analysis.PloS one · 2024Pooled it
- Characteristics and Effectiveness of Interventions That Target the Reporting, Communication, or Clinical Interpretation of Lumbar Imaging Findings: A Systematic Review.AJNR. American journal of neuroradiology · 2022Pooled it
- The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis.BMC musculoskeletal disorders · 2021Pooled it
- Effect of diagnostic labelling on management intentions for non-specific low back pain: A randomized scenario-based experiment.European journal of pain (London, England) · 2022Trial
- Patient education booklet to support evidence-based low back pain care in primary care - a cluster randomized controlled trial.BMC family practice · 2021Trial
- Appropriateness of Lumbar Spine Magnetic Resonance Imaging Requests: Guideline Concordance, Diagnostic Yield, Artificial-Intelligence Assessment and Derivation of a Simple Clinical Decision Rule.Diagnostics (Basel, Switzerland) · 2026Article
- Mechanical energy analysis identifies compensatory strategies in individuals with and without Non-specific chronic low back pain.Scientific reports · 2026Article
- Pertinence of magnetic resonance imaging in lumbar pain: a prospective surgeon-based evaluation of diagnostic concordance and therapeutic impact.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Drivers of unnecessary diagnostic imaging for uncomplicated low back pain among family physicians: a theory-informed qualitative study.Family practice · 2026Article
- Large language models as cost-conscious decision aids in emergency medicine: protocol support for imaging in lower back pain.Emergency radiology · 2026Article
- Is Emergency Department Care for Low Back Pain Meeting Contemporary Standards? A Medical Record Review.Emergency medicine Australasia : EMA · 2026Article
- Factors Associated with Radiological Examination of Patients with Non-Specific Low Back Pain.Journal of clinical medicine · 2025Article
- Beliefs of People With Patellofemoral Pain About Their Condition and Treatments Before and After Self-Directed Access to a Web-Based Education Platform.Musculoskeletal care · 2025Article
- Australian General Practitioners' Use of Diagnostic Lumbar Spine Imaging for Patients With Acute Low Back Pain: A Qualitative Study.Musculoskeletal care · 2025Article
- Musculoskeletal mimics of lumbosacral radiculopathy.Muscle & nerve · 2025Review
- Paramedic Management of Non-Traumatic Back Pain in a Large Australian Ambulance Service: A Retrospective Study.Prehospital and disaster medicine · 2025Article
- How Is Chronic Pain Managed in Rural Australia? A Qualitative Study Exploring Rural Healthcare Professional and Consumer Experiences.The Australian journal of rural health · 2025Article
- A scoping review on implementation processes and outcomes of models of care for low back pain in primary healthcare.BMC health services research · 2024Article
- A critical review of the role of manual therapy in the treatment of individuals with low back pain.The Journal of manual & manipulative therapy · 2024Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeImaging (X-ray, CT and MRI) provides no health benefits for low back pain (LBP) patients and is not recommended in clinical practice guidelines. Whether imaging leads to increased costs, healthcare utilization or absence from work is unclear. Therefore, this study systematically reviews if imaging in patients with LBP leads to an increase in these outcomes.
methodsWe searched PubMed, CINAHL, EMBASE, Cochrane Library and Web of Science until October 2017 for randomized controlled trials (RCTs) and observational studies (OSs), comparing imaging versus no imaging on targeted outcomes. Data extraction and risk of bias assessment was performed independently by two reviewers. The quality of the body of evidence was determined using GRADE methodology.
resultsModerate-quality evidence (1 RCT; n = 421) supports that direct costs increase for patients undergoing X-ray. Low-quality evidence (3 OSs; n = 9535) supports that early MRI may lead to an increase in costs. There is moderate-quality evidence (1 RCT, 2 OSs; n = 3897) that performing MRI or imaging (MRI or CT) is associated with an increase in healthcare utilization (e.g., future injections, surgery, medication, etc.). There is low-quality evidence (5 OSs; n = 15,493) that performing X-ray or MRI is associated with an increase in healthcare utilization. Moderate-quality evidence (2 RCTs; n = 667) showed no significant differences between X-ray or MRI groups compared with non-imaging groups on absence from work. However, low-quality evidence (2 Oss; n = 7765) did show significantly greater mean absence from work in the MRI groups in comparison with the non-imaging groups.
conclusionsImaging in LBP may be associated with higher medical costs, increased healthcare utilization and more absence from work. These slides can be retrieved under Electronic Supplementary Material.
Indexed as
Identifiers
30796513What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.