Low back pain diagnosis

In 85 % of cases no specific diagnosis can be made.

Work status

Typical job tasks

Educational level

Pending litigation

Workers compensation or disability issues

Failed previous treatments

Substance abuse

Depression.

Diagnosing common LBP implies that the pain is not related to conditions such as fractures, spondylitis, direct trauma, or neoplastic, infectious, vascular, metabolic, or endocrine-related processes ^{1) 2)}.

Low back pain physical examination.

Imaging is important in the evaluation of patients with degenerative disease and infectious processes. There are numerous conditions that can manifest as low back pain (LBP) or neck pain in a patient, and in many cases, the cause may be multifactorial. Clinical history and physical examination are key components in the evaluation of such patients ³⁾.

However, physical examination has variable sensitivity and specificity.

Although studies have demonstrated that uncomplicated acute LBP and/or radiculopathy are self-limited conditions that do not warrant any imaging ^{4) 5) 6)} , neuroimaging can provide clear anatomic delineation of potential causes of the patient's clinical presentation. Various professional organizations have recommendations for imaging of LBP, which generally agree that an imaging study is not indicated for patients with uncomplicated LBP or radiculopathy without a red flag (eg, neurological deficit such as major weakness or numbness in lower extremities, bowel or bladder dysfunction, saddle anesthesia, fever, history of cancer, intravenous drug use, immunosuppression, trauma, or worsening symptoms). Different imaging modalities have a complementary role in the diagnosis of pathologies affecting the spine ⁷⁾.

Imaging, primarily with MRI and CT, is used to evaluate the source of both LBP and neck pain. These imaging modalities commonly identify disc degeneration, disc herniations, and posterior element arthopathy; however, the imaging findings of spine degeneration are present in a high proportion of asymptomatic individuals and increase with age ^{8) 9)}

see Lumbar spine magnetic resonance imaging.