Imaging plays a crucial role in diagnosing spinal and musculoskeletal conditions, but it is not always necessary for routine back or joint pain. In many cases, pain resolves with conservative treatment, and unnecessary imaging can lead to anxiety, excessive medical costs, or unwarranted procedures. However, clinical red flag warnings indicate when imaging is essential to rule out serious conditions.

Red flags include severe or worsening pain, unexplained weight loss, fever, history of cancer, recent trauma, or neurological deficits such as weakness, numbness, or loss of bladder or bowel control. These symptoms may signal conditions like infections, fractures, tumors, or spinal cord compression, requiring urgent evaluation.

When red flags are present, imaging such as X-rays, MRIs, or CT scans can help identify the underlying cause. X-rays detect fractures or structural changes, while MRIs provide detailed images of soft tissues, including discs, nerves, and tumors. CT scans may be used for more precise bone assessment. Additionally, flexion-extension X-rays are valuable in evaluating spinal instability, which occurs when the spine moves excessively between positions. This can help diagnose conditions like spondylolisthesis or ligamentous injuries, guiding treatment decisions.

While imaging is valuable in specific cases, it should be used selectively to avoid unnecessary exposure to radiation or incidental findings that do not contribute to treatment. If you experience persistent pain or red flag symptoms, consult your provider to determine whether imaging, including flexion-extension X-rays, is appropriate for your condition.