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Low Back Pain

Up to 90 percent of the U.S. population may have significant low back pain at some point. A common and potentially disabling cause of osteoarthritic pain of the lower back and legs is stenosis of the spinal canal.

Initial Classification of Acute Low Back Symptoms

Sciatica is characterized by back-related, lower limb symptoms suggesting lumbosacral nerve root compromise. Stenosis of the lumbar canal usually may be attributed to acquired degenerative or arthritic changes of the intervertebral discs, ligaments and facet joints surrounding the joint.

Nonspecific back symptoms occur primarily in the back and suggest neither nerve root compromise nor a herniated disk.

Potentially serious spinal conditions include tumor, infection, spinal fracture, or a major neurologic compromise, such as cauda equina syndrome.

In the absence of signs osteoarthritis, arthritis of dangerous conditions, special studies are not required since 90% of patients will recover spontaneously.

Nonmechanical Causes of Low Back Pain

Rheumatologic low back pain, osteoarthritis, arthritis Disease. Polymyalgia rheumatica, fibrositis, ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis, enteropathic arthritis.

Infection. Vertebral osteomyelitis, diskitis, epidural abscess.

Tumor. Osteoma, multiple myeloma, skeletal metastases.

Endocrinologic and Metabolic Disorders. Osteoporosis with osteomalacia.

Referred Pain. Abdominal aortic aneurysm, kidney stone, pyelonephritis.

 Markers for Potentially Serious Conditions


Tumor or Infection

Cauda Equina Syndrome

Major trauma, such as a vehicle accident or a fall from height.

New onset or worsening of back pain after minor trauma or strenuous lifting in an older or osteoporotic patient

Age >50 or <20. History of cancer, fever, chills, weight loss. Pain worsens at rest or when supine; severe nighttime pain.

Risk Factors for Spinal Infection: Recent bacterial infection, UTI, IV drug abuse, diabetics, immunosuppression.


Saddle anesthesia.

Bladder dysfunction (urinary retention, frequency, overflow incontinence).