People with acute low back pain do not need lumbar imaging

Patients with uncomplicated acute or subacute low back pain do not need lumbar imaging, according to a meta-analysis of six randomised trials⇑. Care that includes imaging such as radiographs, computed tomography, or magnetic resonance imaging doesn’t reduce pain, improve function, or affect quality of life.

The trials compared care with and without immediate imaging for people with short term back pain and no symptoms suggesting serious pathology, such as infections, cancer, or cauda equina syndrome. The authors judged five of the six trials to be of reasonably high quality. They found that immediate imaging had no significant effect on any outcome measured between three weeks and one year after the back pain began. The findings were most convincing for primary care patients in trials testing lumbar radiography. Doctors should resist pressure from patients and follow international guidelines that already recommend against imaging, say the authors. It is ineffective, costly, and exposes people to unnecessary radiation or even unnecessary invasive treatments.

A linked editorial endorses this view and suggests educating the public both inside and outside general practitioners’ surgeries (p 436). Some evidence exists that shifting patients’ views can have a durable effect on the way doctors manage acute back pain.

Screening identifies more cases of urinary tract stones in Chinese infants

In September last year the Chinese authorities discovered that many popular brands of infant formula milk were contaminated with the nitrogenous chemical melamine, after an unexpected number of babies and small children developed urinary tract stones. During the ensuing free screening programme, 589 infants under 3 years were screened with ultrasonography at one academic hospital in Beijing. Fifty of them had urinary tract stones (8.5%); 421 had received contaminated formula milk. Infants who were exposed to high amounts of the contaminant were five to seven times more likely to have …