Low back pain ranks second only to the common cold as a reason for primary care visits. Because anatomic abnormalities of the lumbar spine, including disk protrusion, are common in asymptomatic patients, the presence of radiographic findings may be coincidental to back pain and not the true cause of symptoms. Simple back pain is self limiting, and most patients will recover without specific treatment. Plain radiographs are indicated for the evaluation of patients with radiculopathy or with risk factors for underlying medical conditions. The majority of patients with back pain, including those with radiculopathy, improve with conservative management and surgery is unnecessary. Urgent surgical referral is required when the clinical presentation suggests cord compression or cauda equina syndrome.
