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Panel findings and recommendations: 
 -   Thermography is not recommended for assessing patients with low back problems.    (Strength of Evidence = C.) 
  In patients with low back problems, thermography involves measuring small temperature differences between sides of the body and evaluating the patterns on infrared thermographic images of the back and lower extremities.  Because thermography is noninvasive and involves no ionizing radiation, the test has been proposed as a physiologic test with clinical utility for documenting the presence or absence of radiculopathy (nerve root compression). 
Literature Reviewed     Evidence on Efficacy    Potential Harms and Costs      Summary of Findings     
  Literature Reviewed.  Of 17 articles screened for this topic, only 1 met review criteria for adequate evidence about efficacy.267  The panel also reviewed a meta-analysis on thermography.268  Reviewed as well were four articles providing data on thermography in "asymptomatic" subjects without back problems.269, 270, 271, 272 
  Evidence on Efficacy.    The one study meeting review criteria267 evaluated thermography in 107 patients who had sciatica of unspecified duration, 19 of whom went on to have low back surgery, and 28 asymptomatic subjects with no history of back problems and no evidence of disease affecting the lower extremities.  All the asymptomatic subjects had temperature differences on thermography of less than 1.9° C in the feet and less than 1.0° C in other parts of the lower limbs.  These values were used as the upper limits of normal for evaluating patients with sciatica.  Of the 19 patients with sciatica who went on to have surgery, only 53 percent had results on preoperative thermography in agreement with surgical findings. 
  The most recent meta-analysis268 reviewed 81 relevant citations and analyzed 28 studies of thermography used for diagnosing lumbar radiculopathy.  Articles were graded excellent, good, fair, or poor based on the following criteria: technical quality of the reference test, uniform application of the reference test, independence of interpretations, clinical description, cohort assembly, and sample size.  Only excellent and good studies were considered reliable sources of data on diagnostic accuracy.  No study was graded excellent, 1 study was graded good, 3 were graded fair, and the remaining 24 were graded poor.  Because of the methodological flaws in 27 studies, summary pooled statistics were not reported.  The only study considered reliable267 found no discriminant value for thermography in diagnosing lumbar radiculopathy.  True positive and true negative rates were both 48 percent. 
  The four studies evaluating thermography in persons without back problems found abnormal thermography of the lower limbs in 7 to 81 percent of these asymptomatic subjects.  Chafetz, Wexler, and Kaiser,269 evaluating 15 asymptomatic subjects with no current back pain and no history of back surgery or disability from back pain, found that 40 percent had abnormal thermograms. 
  Harper, Low, Fealey, et al.270 evaluated thermography in 37 asymptomatic subjects (carefully screened for no history of back pain, back surgery, or disease or injury affecting the lower extremities) as well as in 55 patients with clinically suspected radiculopathy.  All thermograms were interpreted independently by five readers experienced in thermography who were blinded to all clinical data.  The different readers interpreted thermograms as probably or definitely abnormal in 56 to 81 percent of the asymptomatic controls. 
  Perelman, Adler, and Humphreys271 evaluated thermography in 16 asymptomatic subjects with no low back complaints and found 25 percent of these subjects to have abnormal thermograms.  Tests were considered abnormal if the thermogram had an asymmetric visual pattern, but temperature differences were not measured.  So, Aminoff, and Olney272 evaluated thermography in 30 patients with symptoms of lumbar radiculopathy and in 27 asymptomatic controls.  Thermogram readers were blinded to clinical data.  Abnormal thermograms, defined as temperature differences between sides greater than three standard deviations from the mean for all asymptomatic subjects, were found in 7 percent of the asymptomatic subjects. 
  Potential Harms and Costs.  No reports of significant risks from thermography were found.  Thermography is considered moderately expensive. 
  Summary of Findings.  The one study meeting review criteria found that thermography did not accurately predict either the presence or absence of lumbar nerve root compression found at surgery.  In addition, several studies have shown thermography of the lower limbs as abnormal in a substantial proportion of asymptomatic subjects without back problems. Based on the available research evidence, thermography does not appear effective for diagnosing low back problems. 
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