General Guideline Principles for Follow-Up Diagnostic
Imaging and Testing Procedures of Mid and Low Back Injury
for workers compensation patients
The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Follow-Up Diagnostic Imaging and Testing Procedures of Mid and Low Back Injury.
These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.
The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.
Follow-Up Diagnostic Imaging and Testing Procedures of Mid and Low Back Injury
The choice of diagnostic imaging studies depends on the case-specific clinical presentation, as well as the factors listed in General Considerations section A-13 clinical wisdom.Additionally, there could be circumstances where repeating or switching.
Clinical indications for diagnostic imaging may exist. They include but are not limited to not merely when: an earlier test was subpar and/or structural; the Clinical circumstances alter (e.g., the appearance of new or worsening symptoms, planning for surgery). It is important to keep track of any clinical improvement (such as postoperatively) or decline over time.
Maximizing diagnostic accuracy, reducing negative patient effects, and promoting clinical efficiency can all be achieved by selecting the right procedure(s) or doing numerous procedures in the right order. The cumulative radiation exposure and related dangers rise as a result of repeated procedures.
The sensitivity and specificity of diagnostic imaging methods for any diagnosis can vary. The selection and interpretation of imaging studies should be based on clinical history, physical examination, and clinical judgment.
Plain X-rays are typically a good place to start, but they are not always sufficient. Numerous spinal problems may benefit from information from magnetic resonance imaging (MRI), myelography, or computed axial tomography (CT) scanning performed after myelography.
It is important to understand that repetitive CT exams result in a higher cumulative radiation dosage and associated dangers. Repeat imaging or alternative imaging may be necessary for some situations, as mentioned above. Choosing one method over another typically involves several considerations.
Imaging is typically not clinically indicated until after conservative therapy has been tried and failed, even after initial imaging is performed, as may be indicated by clinical presentation, history of significant trauma, or other clinical “red flags” that raise suspicions for serious underlying conditions.
In the absence of a significant neurologic deficit or abnormality, myelopathy, or progressive neurological changes, imaging is typically not clinically indicated. Before ordering an imaging procedure, a patient should typically get treatment for a minimum of four weeks and as long as six to eight weeks.
However, the doctor may use discretion in this situation. Objective clinical findings should be given more weight when the results of diagnostic imaging and testing techniques do not agree with the findings of the clinical examination.
There is strong evidence that disc degeneration is more common than 50% among those over 40 who are asymptomatic. Loss of signal intensity on an MRI scan indicates disc degeneration, which may be caused by age-related changes that cause biochemical and structural changes apart from traumatic injury and may not be pathologically significant.
Although not uncommon, posterior disc protrusion and disc bulging are less common in the lumbar spine than in the cervical spine due to the latter’s narrower spinal canal. Patients older than 40 may experience a mild loss in the spinal cord’s cross-sectional area without experiencing myelopathy; as a result, clinical correlation is necessary.
Based on the underlying cause, symptoms, and patient history, the following studies may be used to further evaluate mid and low-back injuries when appropriate. The following study is not organized according to preference, therapeutic utility, or clinical indication because these factors can change depending on the specific clinical circumstances of a given case.
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