Low Back Pain Differential Diagnoses
From WikiMSK
Mechanical Low Back Pain (97%)
- Internal disc disruption
- Facet joint pain
- Sacroiliac joint pain
- Sacroiliac ligament pain
- Torsion injuries
- Vertebral or sacral insufficiency fractures
- Interspinous tissue injury
- Lamina impaction
- Scoliosis
- Spondylolysis in a sportsperson, but not the general population
- The following are disputed causes of low back pain: degenerative changes, low grade disc infection, non-specific chronic low back pain, transitional vertebrae, congenital fusion, spina bifida occulta, spondylolisthesis, instability, failed back surgery syndrome, back mice, cluneal nerve entrapment, spinal stenosis, myofascial syndrome
Nonmechanical Spine Conditions (1%)
- Neoplasia (Multiple myeloma, metastatic carcinoma, lymphoma, leukaemia, spinal cord tumours, retroperitoneal tumours, primary vertebral tumours)
- Infection (Osteomyelitis, discitis, paraspinous abscess, epidural abscess, shingles)
- Spondyloarthritis
- Scheuermann disease, especially type II
- Diffuse idiopathic skeletal hyperostosis
- Osteitis Condensans Ilii
- Paget disease
Visceral Disease (2%)
- Pelvic organ involvement (Prostatitis, endometriosis, chronic pelvic inflammatory disease)
- Renal involvement (Nephrolithiasis, pyelonephritis, perinephric abscess)
- Aortic aneurysm
- Gastrointestinal involvement (Pancreatitis, cholecystitis, ulcer)
Epidemiology
Sources of pain in chronic low back pain as a function of age.[1] Copyright ยฉ 2020 American Academy of Pain Medicine
Clinical Features
From Manchikanti et al[2]
References
- โ DePalma et al.. What is the source of chronic low back pain and does age play a role?. Pain medicine (Malden, Mass.) 2011. 12:224-33. PMID: 21266006. DOI.
- โ Manchikanti L, Kaye AD, Soin A, et al. Comprehensive Evidence-Based Guidelines for Facet Joint Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines Facet Joint Interventions 2020 Guidelines. Pain Physician. 2020;23(3S):S1-S127.
Jarvik & Deyo. Diagnostic evaluation of low back pain with emphasis on imaging. Annals of internal medicine 2002. 137:586-97. PMID: 12353946. DOI.
