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Back pain accounts for more than 2.6 million visits
30% of ED patients receive X-rays as part of their evaluation
Imaging can be avoided in a majority of these patients by focusing on high risk (red flags) findings in the history and physical exam.
Patients who can identify a an acute inciting event without direct trauma likely have a MSK source of pain.
Imaging rarely alters management
Attempt to avoid imaging in patients with nonspecific lower back pain of less than 6 weeks duration, with a normal neurologic exam and without high risk findings (fever, cancer, IVDA, bowel or bladder incontinence, age greater than 70, saddle anesthesia, etc)
Patients with radiculopathy (sciatica) and are otherwise similar to the above also do not require emergent imaging