Association of Early Imaging for Back Pain With Clinical Outcomes in Older Adults

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Abstract
When to image older adults with back pain remains controversial. Most guidelines regarding acute or chronic back pain focus on younger age groups. Many guidelines recommend that older adults undergo early imaging because of the higher prevalence of serious underlying conditions.1-4 However, there is not strong evidence to support this recommendation.5 A Cochrane review of back pain in older adults concluded that there was “under-representation of the older population in the back pain literature.”6 Adverse consequences of early imaging are more substantial in an older population because the prevalence of incidental findings on spine imaging increases with age.7-11 Given the high prevalence of incidental findings in this age group, imaging older adults soon after initial presentation may lead to a cascade of subsequent interventions that increase costs without benefits. This phenomenon has been observed in workers’ compensation populations.12,13

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