Does early imaging influence management and improve outcome in patients with low back pain?

INTERVENTION: 1. Early imaging 2. Delayed, selective imaging (that is, only when a clear clinical indication develops and only when judged absolutely necessary by the clinician) A minimisation algorithm will be used to balance the 'random' allocation in respect of key prognostic variables. CONDITION: Musculoskeletal diseases: Spinal conditions ; Musculoskeletal Diseases ; Spinal conditions PRIMARY OUTCOME: The principle measures of patient outcome will be the Oswestry Disability Index and the SF 36 health status measure. Secondary measures will assess diagnostic impact, therapeutic impact and other parameters of health. Follow‐up assessments will be performed at 6 and 24 months after entry. Secondary stratified analyses will explore the effects of pre‐referral lumbar spine radiographs, amongst other factors. SECONDARY OUTCOME: Not provided at time of registration. INCLUSION CRITERIA: Back pain patients referred to a consultant orthopaedic surgeon or neurosurgeon where there is clinical uncertainty about whether or when to perform imaging