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Agency for Care Effectiveness
Published

When to order MRI for low back pain ACG

Condition

Musculoskeletal

Guidance type

ACG

2 June 2026

Published on 01 Oct 2020
Last Updated on 02 Jun 2026

This ACE Clinical Guideline (ACG) covers the use of magnetic resonance imaging (MRI) of the lumbar spine for diagnostic investigation of low back pain, providing evidence-based recommendations on the role of MRI for low back pain that is non-specific or linked to a specific spinal pathology. First published in 2020, this ACG has been updated in 2026 based on the latest evidence.

Download the ACG

When to order MRI for low back pain (Jun 2026) [PDF]

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Registered doctors and pharmacists may claim 1 Continuing Medical Education (CME)/Continuing Professional Education (CPE) point under category 3A for reading each ACG.

ACG recommendations

  1. Patients with non-specific low back pain, with or without radicular symptoms: MRI is not indicated.

  2. Patients with non-specific low back pain despite 4 to 6 weeks of conservative management: MRI may be indicated.

  3. Patients with low back pain and progressive neurological symptoms or signs: MRI is indicated.

  4. Patients with low back pain and suspected cauda equina syndrome: MRI is indicated.

  5. Patients with low back pain and cancer or infection (suspected or known): MRI is indicated.

  6. Patients with new or progressive low back pain following an invasive procedure on the lumbar spine: MRI is indicated.

ACG references

MRI for low back pain references (Jun 2026) [PDF]

ACG EtR framework

The Evidence-to-Recommendation (EtR) framework is a document that outlines the underpinning evidence and rationale for the recommendations in our ACGs. Download the EtR framework below to learn more about factors that have informed the strength of the ACG recommendations, including certainty of evidence, clinical benefit/risk balance, local resource implications, feasibility considerations, patient preferences and values, acceptability and other considerations.

MRI for LBP EtR framework with summary of findings (Jun 2026) [PDF]

Version History

When to order MRI for low back pain

Version no.

Notes

Date of release

1.0

Publication of guideline

01 Oct 2020

2.0

Evidence searches were updated and key changes included the following:

  • Updated percentage of patients with non-specific low back pain, among those with low back pain.

  • New information on “Non-specific low back pain: patient education and reassurance” was added under Recommendation 1 to provide principles of patient counselling when MRI is not required.

  • Computed tomography (CT) mentioned as available imaging modality for the evaluation of suspected vertebral facture.

  • New information regarding the role of imaging in inflammatory back pain was included.

  • Rearranged order of clinical features of cauda equina, due to the limited evidence that sexual dysfunction is an indicator of cauda equina syndrome without associated bladder or bowel dysfunction

  • Rearranged order of clinical features of patients with suspected cancer or infection were rearranged. The clinical features associated with cancer are placed before infection, and the more important clinical features for each condition are mentioned first.

  • Brief specifications added in the text about importance of shared decision making with patients, as well as regarding the type of specific MRI being based on the suspected spinal pathology.

 No changes to the existing Recommendations 1 to 6 were made.

02 Jun 2026

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When to order MRI for low back pain

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