American Board of Family Medicine (ABFM) Practice Exam

In a patient with acute lumbar pain and radiculopathy who shows no signs of serious underlying conditions, is imaging necessary?

1. Yes, always

2. No, it's not needed

3. Only if symptoms persist

4. Only if neurological deficits are present

The correct answer is: No, it's not needed

In cases of acute lumbar pain and radiculopathy, particularly when there are no indications of serious underlying conditions such as fractures, malignancy, or significant neurological deficits, imaging is generally not necessary. The initial approach typically involves a thorough clinical assessment, relying on the patient's history, physical examination, and the clinical presentation of the symptoms. Most acute lumbar pain cases resolve over time without the need for imaging studies. According to clinical guidelines, routine imaging in the absence of red flags can lead to unnecessary procedures, additional healthcare costs, and potential misleading interpretations of findings that may not be clinically significant. Instead, physicians often recommend conservative management, including physical therapy and pain relief measures, with imaging reserved for cases that do not improve or where there are ominous signs indicating the need for further evaluation. This approach is aligned with evidence-based practices that prioritize patient safety and resource optimization in medical care.