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Spine
Imaging of the spine
X-rays
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Spine X-rays appearances change with age and are of little diagnostic to identify degenerative changes.
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X-Ray cannot identify causes of radicular pain (sciatica) so not indicated for this
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Use of Xray is primarily to identify insufficiency fractures - unless there are risk factors for osteoporosis they are not justified if patient age <50 yrs
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Xray is not required prior to an MRI request
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Whole spine Scoliosis or coccyx xray requests accepted from spinal surgeons only
Spine Xray is a high radiation dose procedure - one lumbar spine equates to approx 75 CXR
=
MRI scan
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MRI appropriate to identify causes of radicular pain.
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Referral must include side and distribution of signs/symptoms - see imaging pathways
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MRI not indicated for simple mechanical back pain
Inappropriate spinal imaging can cause harm:
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- Misinterpretation of results by patients resulting in medicalisation of normal changes, fear and avoidance of movement and activity and low expectations of recovery
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-Misinterpretation of results by clinicians resulting in unhelpful advice with needless subsequent investigations and invasive interventions
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- Side effects such as radiation exposure
Imaging Pathways:
Lumbar
pathway
Lumbar
pathway
Thoracic
Pathway
Thoracic
Pathway
cervical
pathway
cervical
pathway
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