Routine Lumbar X-Rays of Limited Value in Assessing Low Back Pain Interview with:
Lingxiao Chen
 | MBBS, MMed, PhD Candidate
The University of Sydney
Institute of Bone and Joint Research | The Kolling Institute
Sydney Medical School | Faculty of Medicine and Health
Statistical Editor of BMJ Open Sport & Exercise Medicine

back pain What is the background for this study?

Response: Current guidelines for treatment of low back pain (LBP) do not recommend routinely using diagnostic imaging, except when patients either present with severe, progressive neurologic deficits or with signs or symptoms indicative of a serious or specific underlying condition (eg, fracture or cancer). Nonetheless, diagnostic imaging is still widely used in clinical practice for low back pain. Previous studies, using mostly cross-sectional data, provide conflicting evidence of an association between lumbar spine radiographic changes and the severity of back pain–related disability. Such conflicting evidence may be associated with widely unnecessary diagnostic imaging of the lumbar spine. What are the main findings?

Response: In this population-based cohort study of women from the UK, there was no evidence to support an association between a higher number of lumbar segments with radiographic changes (Kellgren-Lawrence grade, osteophytes, and disc space narrowing) and more severe back pain–related disability in cross-sectional (650 women) or longitudinal (443 women) analyses. What should readers take away from your report?

Response: The changes (K-L grade, osteophytes, and disc space narrowing) detected on lumbar radiographs provide limited value for decision-making regarding back pain management in this population. What recommendations do you have for future research as a result of this work?

  1. Other radiologic changes, including spondylolisthesis or vertebral body height (ie, osteoporotic fractures), should be explored.
  2. Future studies should include participants of both sexes and larger sample sizes and should include multiple centers to increase external validity.
  3. The association between the findings of complex imaging (eg, computed tomography scans, magnetic resonance imaging, or nuclear bone scans) and symptom severity in people with LBP needs to be further explored, considering the increasing use of such imaging.

No disclosures


Chen L, Perera RS, Radojčić MR, et al. Association of Lumbar Spine Radiographic Changes With Severity of Back Pain–Related Disability Among Middle-aged, Community-Dwelling Women. JAMA Netw Open. 2021;4(5):e2110715. doi:10.1001/jamanetworkopen.2021.10715

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