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<pre>
210109

Without LL symptoms

With LL symptoms
pain, weakness, paraesthesia

Consider immediate investigations
(eg plain XR, CBE, ESR, CT scan, 
MRI, bone scan, bone densitometry, 
urinalysis)

Non-specific LBP Non-specific LBP

Consider  
investigations if 
symptoms persist 
beyond 12 weeks: 
plain XR (if no prior XR) 
or MRI (See Note 1)

Consider 
investigations if 
symptoms persist 
beyond 12 weeks: 
plain XR (if no prior XR) 
or MRI (See Note 1)

Consider investigations 
after 4 6 weeks if 
radicular symptoms 
are severe enough 
to consider surgical 
intervention 
(See Notes 1 and 2)

Consider earlier 
investigations if 
neurological deficits are 
severe or progressive

Radiculopathy

Consider investigations 
if claudicant symptoms 
are of sufficient duration 
(often several months) 
and severity to consider 
surgical intervention 
(See Notes 1 and 2)

Consider earlier 
investigations if 
neurological deficits are 
severe or progressive

Spinal claudication

Urgent MRI 
required to assess 
for cauda equina 
compression

Immediate specialist 
consultation indicated 
See triage and referral 

guideline for contact 
details

Acute cauda  
equina syndrome

*Red flag screening
Age (at onset) &gt;
over 55

Recent significant &gt;
trauma

Unexplained &gt;
weight loss

History of cancer &gt;

History of IV &gt;
drug use

Prolonged use of &gt;
corticosteroids

Features of cauda &gt;
equina syndrome

Severe, worsening &gt;
pain; especially
at night

Fever &gt;

See diagnostic algorithm for detail of clinical presentations

Note 1:   Lumbar MRI is usually the screening modality of choice for the investigation of lumbar disorders. Self-funded MRIs are 
available via GP referral at a cost of approximately $250 (not Medicare rebatable). If MRI is not available or affordable,  
lumbar CT may be indicated, with consideration given to risks of radiation exposure   particularly in the case of repeated 
imaging and younger patients (&lt;50 years).

Note 2:   Imaging is not an essential component of referral information if a clear clinical diagnosis can be made.

Low back pain
+/- lower limb (LL) symptoms

Red flags
present*

No red
flags*

For more information Web: www.sahealth.sa.gov.au/lumbardisorders  Document updated: September 2021

Orthopaedic Spinal Services 

Lumbar disorders   imaging guideline




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