When to image
Most acute low back pain needs no imaging (≤ 6 weeks without red flags). Red flags: trauma, cancer history, fever/IV drug use/immunosuppression (infection), weight loss, progressive neurological deficit, cauda equina symptoms, age > 50 with new pain, osteoporosis/steroids. MRI = IOC for discs, cord, nerve roots, marrow, infection, tumour. CT for bony trauma; radiographs for alignment, instability and deformity.