Diagnostic tests for the evaluation of back and neck pain.

The number of available diagnostic tests for patients with back and neck pain has grown dramatically over the past two decades, and their cost has increased as well. The impact of managed care and an increased understanding of the natural history of these conditions have led to close evaluation of the sensitivity and specificity of these tests and their effect on patient outcomes. Advanced anatomic and physiologic tests within the first month should be reserved for patients with red flags for serious pathologic conditions on clinical examination. Specific criteria are being developed for each electrodiagnostic and imaging test in the evaluation of the patient whose symptoms do not resolve within 1 month. Guidelines for the testing of patients with chronic back and neck pain have yet to be developed. Stronger emphasis on psychosocial issues and the assurance that pathologic progression has not been missed without the use of repetitive testing form the mainstay of diagnostic protocols in this population.