Table 1. Initial Evaluation of LBP: Diagnostic Work-Up Imaginga
Possible Cause Key Features on History or Physical Examination
Cancer
> History of cancer with new onset of LBP
> Unexplained weight loss > Failure to improve after 1 month
> Age > 50 years > Multiple risk factors present
Vertebral infection > Fever > Intravenous drug use > Recent infection
Cauda equina syndrome
Vertebral compression fracture
Ankylosing spondylitis
> Urinary retention > Motor deficits at multiple levels > Fecal incontinence > Saddle anesthesia
> History of osteoporosis > Use of corticosteroids > Older age
> Morning stiffness > Improvement with exercise > Alternating buttock pain > Awakening due to back pain
> Younger age
Severe/progressive neurologic deficits
Herniated disc (Perform diagnostic studies)
> Progressive motor weakness
> Back pain with leg pain in an L4, L5, or S1 nerve root distribution
MRI
Lumbosacral plain radiography
Plain radiography or MRI
MRI MRI
Lumbosacral plain radiography
during the second part of the night
Anterior- posterior pelvis plain radiography
MRI None
> Positive straight-leg-raise test or crossed straight-leg-raise test
> Symptoms present > 1 month
Spinal stenosis (Perform diagnostic studies)
> Radiating leg pain > Older age (pseudoclaudication a weak predictor)
> Symptoms present > 1 month a Level of evidence for diagnostic evaluation is variable. MRI None MRI
Consider EMG/ NCV
None
Consider EMG/ NCV
3
ESR and/or CRP
None None
ESR and/ or CRP, HLA-B27
ESR
Additional Studiesa
Consider EMG/ NCV
None
