Bmj Usa: Letter


BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E27

This article originally appeared in BMJ USA

As of March 15, eight e-letters had been posted on in response to the paper by Kendrick et al, along with four replies from the authors. Several of these are published below, in whole or in part.—Editor

Agreed! Refrain from lumbar spine x ray

  1. William Stevenson, consultant radiologist (
  1. Burnley, Lancashire, UK
  2. St Thomas Health Centre, Exeter, UK
  3. University of York, York, UK
  4. Royal Victoria Infirmary, Newcastle upon Tyne, UK
  5. University of Nottingham, UK

    Editor—Although the conclusions of this paper are hardly a surprise, the research does provide support for those wishing to discourage the use of this virtually worthless examination, which imposes a significant population radiation dose. Disguised as reassurance for patient and doctor, lumbar spine x ray images are obtained to give the impression to patients that something is being done, thereby removing them from the consultation.

    It can hardly be a surprise to hospital doctors and general practitioners (GPs) that radiography for routine back pain virtually never leads to any benefit to patients to balance the slightly increased risk of cancer (from the added radiation) that may result from radiation exposure. While it is difficult to write down what routine back pain is, we all have a high degree of certainty in knowing it when we see it.

    It is hard to conceive of what benefit there could be. Setting aside any nebulous psychological effect (consideration of which should be strongly discouraged), something would have to happen to the back pain sufferer as a result of the radiographic procedure. Whatever one's views of the relative merits of surgery, pain clinics, aromatherapy, etc, it cannot be argued that plain x ray films have any role in the selection of patients for them. Clinical features: yes; x ray: no.

    There were 420 patients in the trial reported by Kendrick et al. This is only a …

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