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Finding Needles in a Haystack

RICHARD A. DEYO, MD, MPH

Arch Intern Med. 1989;149(1):27-29.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Back pain is a pervasively common problem, one often considered part of the orthopedic surgeon's domain. However, this patient complaint is common in the offices of internists¹ and rheumatologists² as well and rarely requires surgery. Some authors assert that plain roentgenography is part of the "minimal evaluation" for all patients with low-back pain. For a variety of reasons, however, there is a growing consensus that lumbar spine roentgenography should be limited to See also p 47. carefully selected patients^3-5 and a small number of views.^4,6,7 The value of plain films is restricted by a low yield of findings that alter therapy,⁸ a poor association between roentgenographic findings and patient symptoms, ^8,9 failure to reveal important lesions that clearly cause pain (eg, herniated disks), substantial gonadal irradiation, ¹⁰ frequent disagreements in interpretation, ¹¹ and large aggregate costs.

Perhaps because of conflicting expert recommendations in the past, . . . [Full Text PDF of this Article]

Author Affiliations
Northwest Health Services Research and Development Field Program Seattle Veterans Administration Medical Center (152) 1660 S Columbian Way Seattle, WA 98108

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