A systematic review including 31 studies (only two prospective) was abstracted in DARE. The ORs of the association between degeneration ad low back pain ranged from 1.21 to 3.32, with most 95% CIs not including 1, indicating a statistically significant positive association. The ORs for spondylolysis and spondylolisthesis ranged from 0.33 to 2.12, with most CIs including 1. Only a few studies of acceptable quality reported on the association between spina bifida, transitional vertebrae, spondylosis, and Scheuermann´s disease. In general, these findings were not associated with non-specific low back pain.
A technology assessment report on the use of plain radiography in low back pain was abstracted in the Health Technology Assessment Database. The assessment consisted of a RCT of 153 patients and an observational study with 506 patients. In the RCT, referral to lumbar spine x-ray led to a small improvement in patient psychological well-being, but there were no differences in physical outcomes. The authors conclude that there are few significant diffrences at 6 weeks or 1 year between patients who are referred to x-ray and those who are not. Referring to x-ray leads to higher costs.