Spine problems in emergency department patients: does every patient need an x-ray?

Two hundred adults with spine problems were evaluated by one examiner in a community hospital emergency department. A patient was considered to have a spine problem requiring evaluation if presenting with pain in the neck or back not obviously caused by a process outside of the spine (eg, back pain in a patient with renal colic); if there was known or suspected trauma to the neck or back; or if the clinical setting suggested spinal tumor, infection, metabolic bone disease, or ankylosing spondylitis. Of the 200 patients, 143 were studied by x-ray films. Six patients (6 of 143, or 4%) had x-ray abnormalities that mandated specific treatment. Fifty-two of the 57 patients not receiving x-ray studies were followed up at 2 months. Thirty-three of these patients (63%) had no x-ray studies in the interim and had improved greatly. Nineteen (37%) had been studied radiographically in the interim, but no abnormality requiring specific treatment was found in any patient. Emergency physicians should be aware that x-ray studies of the spine have low utility for patients whose histories and examinations are benign, that especially for women lumbosacral x-ray studies involve high gonadal radiation exposure, and that selected patients can be managed without x-ray studies and still be satisfied recipients of adequate medical care.