AHCPR TABLE SUM

<BODY BACKGROUND="d4c2_i000068.jpg" TEXT=#000000 LINK=#0000FF VLINK=#FF0000 BGCOLOR=#FFFFFF > <BASE TARGET="_top"> <DIV class=s20 style='margin-left: 27mm;'> <B><A class=s20 HREF="d4c2-00004e.htm">Prior Page</A> </B></DIV> <DIV class=s20> <B>Summary </B><FONT style='font-size:8pt;'>of still valid </FONT><B>AHCPR </B><FONT style='font-size:8pt;'>Guide #14 </FONT><B>"Findings & Recommendations" Statements </B><FONT style='font-size:8pt;'>(see </FONT><FONT style='font-size:8pt;'><B><A class=s20 HREF="d4c2-000003.htm#an0">Strength of Evidence</A></B></FONT><FONT style='font-size:8pt;'>) </FONT></DIV> <DIV class=s0> <TABLE WIDTH="100%" BORDER="0" CELLPADDING="2" CELLSPACING="2" > <TR> <TD WIDTH=88 VALIGN=TOP BGCOLOR=#E1E1E1> <DIV class=s19 style='margin-top: 2mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'> </FONT></DIV> </TD> <TD WIDTH=201 VALIGN=TOP BGCOLOR=#00FF00> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-top: 2mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'><B></B></FONT><FONT style='font-size:11pt;'> </FONT><FONT style='font-size:11pt;'><B>Recommend</B></FONT></DIV> </TD> <TD WIDTH=126 VALIGN=TOP BGCOLOR=#FFFF00> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-top: 2mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'><B></B></FONT><FONT style='font-size:11pt;'><B>Option</B></FONT></DIV> </TD> <TD WIDTH=228 VALIGN=TOP BGCOLOR=#FF0000> <DIV class=s19 style='margin-left: 2mm;margin-top: 2mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'><B></B></FONT><FONT style='font-size:11pt;'><B>Recommend against </B></FONT></DIV> </TD></TR></TABLE></B></DIV> <DIV class=s0> <TABLE WIDTH="99%" BORDER="0" CELLPADDING="2" CELLSPACING="2" > <TR> <TD WIDTH=88 VALIGN=TOP BGCOLOR=#DDDDDD> <DIV class=s19 style='margin-top: 2mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><B><A class=s19 HREF="d4c2-000004.htm">History</A> and <A class=s19 HREF="d4c2-000004.htm#an0">Physical Exam</A> </B></FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:8pt;'><B>34 studies</B></FONT></DIV> </TD> <TD WIDTH=201 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-top: 2mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><A class=s19 HREF="d4c2-000004.htm#an1">Basic history</A> (B). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:8pt;'>History of cancer/infection (B). “<A class=s19 HREF="d4c2-00003f.htm#an0">Red Flags</A>” </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:8pt;'>Cauda equina syndrome (C). “<A class=s19 HREF="d4c2-00003f.htm#an0">Red Flags</A>” </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:8pt;'>History of significant trauma (C). “<A class=s19 HREF="d4c2-00003f.htm#an0">Red Flags</A>” </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:8pt;'>Psychosocial history (C). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:8pt;'><A class=s19 HREF="d4c2-00003f.htm#an4">Straight leg raising test</A> (B). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-bottom: 1mm;'> <FONT style='font-size:8pt;'>Focused neurological exam (B).</FONT></DIV> </TD> <TD WIDTH=129 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-top: 2mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><A class=s19 HREF="d4c2-000036.htm#an22">Pain drawing</A> and </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-bottom: 1mm;'> <FONT style='font-size:8pt;'>  Visual Analog Scale (D).</FONT></DIV> </TD> <TD WIDTH=225 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='margin-top: 2mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'>  </FONT></DIV> </TD></TR></TABLE></DIV> <DIV class=s0> <TABLE WIDTH="100%" BORDER="0" CELLPADDING="2" CELLSPACING="2" BGCOLOR=#E8E8E8 > <TR> <TD WIDTH=88 VALIGN=TOP BGCOLOR=#E1E1E1> <DIV class=s19 style='margin-top: 2mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><B><A class=s19 HREF="d4c2-000006.htm">Patient Education</A> </B></FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:8pt;'><B>14 studies</B></FONT></DIV> </TD> <TD WIDTH=201 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-top: 2mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><A class=s19 HREF="d4c2-000042.htm#an1">Patient education</A> about back problems (B). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-bottom: 1mm;'> <FONT style='font-size:8pt;'>Back school in occupational settings (C).</FONT></DIV> </TD> <TD WIDTH=129 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'>Back school in non-occupational settings(C).</FONT></DIV> </TD> <TD WIDTH=225 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='margin-top: 2mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'>  </FONT></DIV> </TD></TR></TABLE></DIV> <DIV class=s0> <TABLE WIDTH="100%" BORDER="0" CELLPADDING="2" CELLSPACING="2" > <TR> <TD WIDTH=88 VALIGN=TOP BGCOLOR=#E2E2E2> <DIV class=s19 style='margin-top: 2mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><B><A class=s19 HREF="d4c2-00000a.htm">Medication</A> </B></FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:8pt;'><B>23 studies</B></FONT></DIV> </TD> <TD WIDTH=201 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-top: 2mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'>Acetaminophen (C). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-bottom: 1mm;'> <FONT style='font-family:"Times New Roman";font-size:8pt;'>NSAIDs</FONT><FONT style='font-size:8pt;'> (B).</FONT></DIV> </TD> <TD WIDTH=129 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-top: 2mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'>Muscle relaxants(C). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-bottom: 1mm;'> <FONT style='font-size:8pt;'><A class=s19 HREF="d4c2-000042.htm#an0">Opioids</A>, short course(C).</FONT></DIV> </TD> <TD WIDTH=225 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='margin-top: 2mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'>Opioids used >2 wks (C). </FONT></DIV> <DIV class=s19> <FONT style='font-size:8pt;'>Phenylbutazone (C). </FONT></DIV> <DIV class=s19> <FONT style='font-size:8pt;'>Oral steroids (C). </FONT></DIV> <DIV class=s19> <FONT style='font-size:8pt;'>Colchicine (B). </FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:8pt;'>Antidepressants (C). </FONT></DIV> </TD></TR></TABLE></DIV> <DIV class=s0> <TABLE WIDTH="100%" BORDER="0" CELLPADDING="2" CELLSPACING="2" > <TR> <TD WIDTH=87 VALIGN=TOP BGCOLOR=#E4E4E4> <DIV class=s19 style='margin-top: 2mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><B><A class=s19 HREF="d4c2-000011.htm">Physical Treatment Methods</A> </B></FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:8pt;'><B>42 studies</B></FONT></DIV> </TD> <TD WIDTH=201 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><A class=s19 HREF="d4c2-000042.htm#an0">Manipulation</A> during first month of low back pain without radiculopathy (</FONT><FONT style='color:#FF0000;font-size:8pt;'>B</FONT><FONT style='font-size:8pt;'>).</FONT></DIV> </TD> <TD WIDTH=129 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'>Manipulation for patients with radiculopathy(C). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:8pt;'>Manipulation questionable for patients with symptoms >1 month (C). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:8pt;'>Self-application heat/cold to back (D) </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:8pt;'>Shoe insoles(C). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:8pt;'>Corset for prevention </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-bottom: 1mm;'> <FONT style='font-size:8pt;'>  in occupational setting(</FONT><FONT style='color:#FF0000;font-size:8pt;'>C</FONT><FONT style='font-size:8pt;'>).</FONT></DIV> </TD> <TD WIDTH=225 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'>Manipulation for patients with undiagnosed neurologic deficits (D). </FONT></DIV> <DIV class=s19> <FONT style='font-size:8pt;'>Prolonged course of manipulation (D). </FONT></DIV> <DIV class=s19> <FONT style='font-size:8pt;'>Traction (B). </FONT></DIV> <DIV class=s19> <FONT style='font-family:"Times New Roman";font-size:8pt;'>Transcutaneous Nerve Stimulation <A class=s19 HREF="d4c2-000036.htm#an33">TENS</A> (C). </FONT></DIV> <DIV class=s19> <FONT style='font-size:8pt;'>Biofeedback (C). </FONT></DIV> <DIV class=s19> <FONT style='font-size:8pt;'>Shoe lifts (D). </FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:8pt;'>Corset for treatment (D). </FONT></DIV> </TD></TR></TABLE></DIV> <DIV class=s0> <TABLE WIDTH="100%" BORDER="0" CELLPADDING="2" CELLSPACING="2" > <TR> <TD WIDTH=86 VALIGN=TOP BGCOLOR=#DFDFDF> <DIV class=s19 style='margin-top: 2mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><B><A class=s19 HREF="d4c2-000019.htm">Injections</A> </B></FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:8pt;'><B>26 studies</B></FONT></DIV> </TD> <TD WIDTH=201 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-top: 2mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'> </FONT></DIV> </TD> <TD WIDTH=129 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'>Epidural steroid injections for radicular pain to avoid surgery( C).</FONT></DIV> </TD> <TD WIDTH=225 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'>Epidural injections for back pain without radiculopathy (</FONT><FONT style='color:#FF0000;font-size:8pt;'>D</FONT><FONT style='font-size:8pt;'>). </FONT></DIV> <DIV class=s19> <FONT style='font-size:8pt;'>Trigger point injections (</FONT><FONT style='color:#FF0000;font-size:8pt;'>C</FONT><FONT style='font-size:8pt;'>). </FONT></DIV> <DIV class=s19> <FONT style='font-size:8pt;'>Ligamentous injections (</FONT><FONT style='color:#FF0000;font-size:8pt;'>C</FONT><FONT style='font-size:8pt;'>). </FONT></DIV> <DIV class=s19> <FONT style='font-size:8pt;'>Facet joint injections (</FONT><FONT style='color:#FF0000;font-size:8pt;'>C</FONT><FONT style='font-size:8pt;'>). </FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:8pt;'>Needle acupuncture (</FONT><FONT style='color:#FF0000;font-size:8pt;'>D</FONT><FONT style='font-size:8pt;'>). </FONT></DIV> </TD></TR></TABLE></DIV> <DIV class=s0> <TABLE WIDTH="100%" BORDER="0" CELLPADDING="2" CELLSPACING="2" > <TR> <TD WIDTH=86 VALIGN=TOP BGCOLOR=#E1E1E1> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><B>Bed Rest</B><B>  4 studies</B></FONT></DIV> </TD> <TD WIDTH=201 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-top: 2mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'> </FONT></DIV> </TD> <TD WIDTH=129 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'>Bed rest of 2-4 days for severe radiculopathy (D).</FONT></DIV> </TD> <TD WIDTH=225 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='margin-top: 2mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'>Bed rest > 4 days (</FONT><FONT style='color:#FF0000;font-size:8pt;'>B</FONT><FONT style='font-size:8pt;'>). </FONT></DIV> </TD></TR></TABLE></DIV> <DIV class=s0> <TABLE WIDTH="99%" BORDER="0" CELLPADDING="2" CELLSPACING="2" > <TR> <TD WIDTH=87 VALIGN=TOP BGCOLOR=#DFDFDF> <DIV class=s19 style='margin-top: 2mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><B><A class=s19 HREF="d4c2-00001e.htm">Activities and Exercise</A> </B></FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:8pt;'><B>20 studies</B></FONT></DIV> </TD> <TD WIDTH=201 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-top: 2mm;'> <FONT style='font-size:7pt;'>T</FONT><FONT style='font-size:8pt;'>emporary reduction of activities that increase mechanical stress on spine as necessary (D). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:8pt;'>Gradual return to <A class=s19 HREF="d4c2-000042.htm#an2">normal activities ASAP</A> (</FONT><FONT style='color:#FF0000;font-size:8pt;'>B</FONT><FONT style='font-size:8pt;'>). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:8pt;'>If limited - Low-stress <A class=s19 HREF="d4c2-000059.htm#an3">aerobic exercise</A>(C). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:8pt;'>Conditioning exercises for <A class=s19 HREF="d4c2-000059.htm#an3">trunk</A> </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:8pt;'><A class=s19 HREF="d4c2-000059.htm#an3">  muscles</A> after 2 weeks of limitation (C). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-bottom: 1mm;'> <FONT style='font-size:8pt;'>Exercise quotas(C).</FONT></DIV> </TD> <TD WIDTH=129 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-top: 2mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'> </FONT></DIV> </TD> <TD WIDTH=225 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'>Back specific exercise machines (D). </FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:8pt;'>Therapeutic stretching of back muscles (D). </FONT></DIV> </TD></TR></TABLE></DIV> <DIV class=s0> <TABLE WIDTH="45%" BORDER="0" CELLPADDING="2" CELLSPACING="2" > <TR> <TD WIDTH=0 VALIGN=TOP BGCOLOR=#DFDFDF> <DIV class=s19> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><B>Detect </B></FONT></DIV> <DIV class=s19> <FONT style='font-size:8pt;'><B></B></FONT><FONT style='font-size:9pt;'><B> </B><B><A class=s19 HREF="d4c2-000025.htm">Abnormal</A> </B></FONT></DIV> <DIV class=s19> <FONT style='font-size:7pt;'><B></B></FONT><FONT style='font-size:8pt;'><B><A class=s19 HREF="d4c2-000025.htm">Physiology</A> </B></FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:7pt;'><B></B></FONT><FONT style='font-size:8pt;'><B>14 studies</B></FONT></DIV> </TD> <TD WIDTH=198 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:7pt;'>BP n</FONT><FONT style='font-size:8pt;'>ot improving after 1 month: ? Bone scan (C). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:8pt;'>Radiculopathy? Needle </FONT><FONT style='font-family:"Times New Roman";font-size:8pt;'><A class=s19 HREF="d4c2-000036.htm#an11">EMG</A></FONT><FONT style='font-size:8pt;'> and H-reflex tests to clarify nerve root compromise(C). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-bottom: 1mm;'> <FONT style='font-size:8pt;'>? <A class=s19 HREF="d4c2-000036.htm#an26">SEP</A> to assess spinal stenosis (C).</FONT></DIV> </TD> <TD WIDTH=130 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-top: 2mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'>                                  </FONT></DIV> </TD> <TD WIDTH=225 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'>EMG for clinically obvious radiculopathy (D). </FONT></DIV> <DIV class=s19> <FONT style='font-size:8pt;'>Surface EMG and F-wave tests (C). </FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:8pt;'>Thermography (C). </FONT></DIV> </TD></TR></TABLE></DIV> <DIV class=s0> <TABLE WIDTH="100%" BORDER="0" CELLPADDING="2" CELLSPACING="2" > <TR> <TD WIDTH=88 VALIGN=TOP BGCOLOR=#E0E0E0> <DIV class=s19 style='margin-top: 2mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><B><A class=s19 HREF="d4c2-000029.htm">X-rays  of L-S pine </A> </B></FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:8pt;'><B>18 studies</B></FONT></DIV> </TD> <TD WIDTH=201 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'>When “<A class=s19 HREF="d4c2-00003f.htm#an0">Red Flags</A>” for fracture present(C). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-bottom: 1mm;'> <FONT style='font-size:8pt;'>When “</FONT><FONT style='color:#FFFFFF;font-size:8pt;'><A class=s19 HREF="d4c2-00003f.htm#an0" TARGET=_new >Red Flags</A></FONT><FONT style='font-size:8pt;'>” for cancer or infection present(C).</FONT></DIV> </TD> <TD WIDTH=129 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-top: 2mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'>                                   </FONT></DIV> </TD> <TD WIDTH=225 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'>Routine use in first month of symptoms in absence of "RED FLAGS "(B). </FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:8pt;'>Routine oblique views (B). </FONT></DIV> </TD></TR></TABLE></DIV> <DIV class=s0> <TABLE WIDTH="99%" BORDER="0" CELLPADDING="2" CELLSPACING="2" > <TR> <TD WIDTH=89 VALIGN=TOP BGCOLOR=#E0E0E0> <DIV class=s19 style='margin-top: 2mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><B><A class=s19 HREF="d4c2-00002a.htm">Imaging</A> </B></FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:7pt;'><B></B></FONT><FONT style='font-size:8pt;'><B>18 studies</B></FONT></DIV> </TD> <TD WIDTH=201 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-family:"Times New Roman";font-size:7pt;'>? <A class=s19 HREF="d4c2-000036.htm#an6">CT</A> or <A class=s19 HREF="d4c2-000036.htm#an17">MRI</A> when strongly suspect Cauda equina, tumor, infection, or fracture C). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:7pt;'>? MRI test of choice for patients with prior back surgery (D). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-bottom: 1mm;'> <FONT style='font-size:7pt;'>Criteria for imaging tests (B).</FONT></DIV> </TD> <TD WIDTH=129 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><A class=s19 HREF="d4c2-000045.htm#an8">Myelography or </FONT><FONT style='font-family:"Times New Roman";font-size:8pt;'>CT</FONT><FONT style='font-size:8pt;'>-Myelography</A> for preoperative planning (D).</FONT></DIV> </TD> <TD WIDTH=225 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'>Use of imaging test before one month in absence of "Red Flags"(B). </FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:8pt;'><A class=s19 HREF="d4c2-00002f.htm">Discography or </FONT><FONT style='font-family:"Times New Roman";font-size:8pt;'>CT</FONT><FONT style='font-size:8pt;'>-discography</A> (C). </FONT></DIV> </TD></TR></TABLE></DIV> <DIV class=s0> <TABLE WIDTH="65%" BORDER="0" CELLPADDING="2" CELLSPACING="2" BGCOLOR=#E9E9E9 > <TR> <TD WIDTH=89 VALIGN=TOP BGCOLOR=#DFDFDF> <DIV class=s19 style='margin-top: 2mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><B><A class=s19 HREF="d4c2-000030.htm">Surgical</A> </B></FONT></DIV> <DIV class=s19> <FONT style='font-size:7pt;'><B></B></FONT><FONT style='font-size:8pt;'><B><A class=s19 HREF="d4c2-000030.htm">Issues</A> </B></FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:8pt;'><B>14 studies     </B></FONT><FONT style='color:#FFFFFF;font-size:7pt;'><B> </B></FONT></DIV> </TD> <TD WIDTH=201 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'>Discuss possible <A class=s19 HREF="d4c2-000048.htm">surgical options</A> with patients with persistent and severe sciatica and clinical evidence of nerve root compromise after 1 month of conservative therapy (</FONT><FONT style='color:#FF0000;font-size:8pt;'>B</FONT><FONT style='font-size:8pt;'>). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;'> <FONT style='font-size:8pt;'>Standard discectomy and micro-discectomy of similar efficacy in treatment of herniated disc (B). </FONT></DIV> <DIV class=s19 style='text-indent: -1mm;margin-left: 4mm;margin-bottom: 1mm;'> <FONT style='font-size:8pt;'>Chymopapain, after ruling out allergic sensitivity, acceptable but less efficacious than discectomy for herniated disc(C).</FONT></DIV> </TD> <TD WIDTH=129 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19> <FONT style='font-size:7pt;'>                                  </FONT></DIV> </TD> <TD WIDTH=225 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19> <FONT style='font-size:7pt;'>D</FONT><FONT style='font-size:8pt;'>isc surgery for back pain alone, no "<A class=s19 HREF="d4c2-00003f.htm#an0">Red Flags</A>," and no nerve root compression (</FONT><FONT style='color:#FF0000;font-size:8pt;'>D</FONT><FONT style='font-size:8pt;'>). </FONT></DIV> <DIV class=s19> <FONT style='font-size:8pt;'>Percutaneous discectomy, less efficacious than chymopapain (</FONT><FONT style='color:#FF0000;font-size:8pt;'>C</FONT><FONT style='font-size:8pt;'>). </FONT></DIV> <DIV class=s19> <FONT style='font-size:8pt;'>Surgery for spinal stenosis within the first 3 months of symptoms (D). </FONT></DIV> <DIV class=s19> <FONT style='font-size:8pt;'>Stenosis surgery by</FONT><FONT style='font-size:8pt;'><B> </B></FONT><FONT style='font-size:8pt;'>imaging tests</FONT><FONT style='font-size:8pt;'><B> </B></FONT><FONT style='font-size:8pt;'>rather than Cauda equina syndrome or neuroclaudication (D). </FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:8pt;'>Fusion without motion & stenosis fracture, dislocation, tumor or infection complications(</FONT><FONT style='color:#FF0000;font-size:8pt;'>C</FONT><FONT style='font-size:8pt;'>).* </FONT></DIV> </TD></TR></TABLE></DIV> <DIV class=s0> <TABLE WIDTH="91%" BORDER="0" CELLPADDING="2" CELLSPACING="2" > <TR> <TD WIDTH=67 VALIGN=TOP BGCOLOR=#E1E1E1> <DIV class=s19 style='margin-top: 2mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><B><A class=s19 HREF="d4c2-000068.htm">Non-</B></FONT><FONT style='font-size:7pt;'><B>physical</A> </B></FONT></DIV> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:7pt;'><B></B></FONT><FONT style='font-size:8pt;'><B><A class=s19 HREF="d4c2-000068.htm">Factors</A></B></FONT></DIV> </TD> <TD WIDTH=199 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:7pt;'></FONT><FONT style='font-size:8pt;'><A class=s19 HREF="d4c2-000068.htm">Social, economic, and non-physical factors</A> can alter patient’s response to symptoms or care (D).*</FONT></DIV> </TD> <TD WIDTH=128 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19> <FONT style='font-size:7pt;'>                                  </FONT></DIV> </TD> <TD WIDTH=225 VALIGN=TOP BGCOLOR=#BCC5C5> <DIV class=s19 style='margin-bottom: 1mm;'> <FONT style='font-size:7pt;'>B</FONT><FONT style='font-size:8pt;'>efore extensive Evaluations or Treatment Programs, explore patient <A class=s19 HREF="d4c2-000049.htm#an0">expectations & non-physical factors</A> (</FONT><FONT style='color:#FF0000;font-size:8pt;'>D</FONT><FONT style='font-size:8pt;'>). </FONT></DIV> </TD></TR></TABLE></DIV> <DIV class=s19>  </DIV> <DIV class=s20 style='margin-left: 28mm;'> <B><A class=s20 HREF="d4c2-00004e.htm">Prior Page</A> </B></DIV> <DIV class=s0>  </DIV> <DIV class=s3 style='margin-top: 0mm;margin-bottom: 1mm;'> <FONT style='font-family:"Arial";font-size:8pt;'><B></B><B>SRC Spinemate - only used or reproduced with written permission from SResourceC@aol.com </B></FONT></DIV>