Low-back pain is a very common but benign and in general self-limiting disease indicating that only a small proportion of the patients will require sophisticated imaging studies. Recent studies have highlighted that a simple relation of structural abnormalities to low-back pain is impossible because similar alterations can be found in symptomatic as well as in asymptomatic individuals. These findings question our current criteria for the diagnosis of low-back pain disorders with regard to their discriminative power in differentiating diseased and non-diseased individuals. Structural abnormalities demonstrated by imaging studies should therefore only be interpreted in the light of the clinical findings. This review has shown that only a few studies contribute to our understanding of the clinical efficacy of imaging studies in the evaluation of low-back pain disorders. There is an absolute need for comprehensive well conducted studies on the impact of specific image modalities on diagnosis and treatment of lumbar spinal disease.
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