In Reply. — Our study was a descriptive one in which care provided to patients with acute low-back pain at three walk-in clinics was reviewed.1 We found that practicing physicians at the three clinics tended to order lumbosacral spine roentgenograms more often for patients with certain clinical characteristics, but these data cannot be used to derive the best criteria for obtaining spine roentgenograms.
Drug or alcohol abuse was uncommon in our study population (25 [5.3%] of 471 patients).1 Most of these patients were abusing alcohol, not intravenous drugs. However, intravenous drug use is a significant and growing problem in many clinical settings. Individuals who are actively abusing intravenous drugs are well known to be at increased risk of developing serious infections. Chandrasekar rightly points out that physicians must main
tain a heightened suspicion of infectious pathologic findings when these patients present with back pain, even though the clinical