Low Back Pain Differential Diagnoses

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. Copyright © 2020 American Academy of Pain Medicine

Clinical Features

From Manchikanti et al

References

Jarvik & Deyo. Diagnostic evaluation of low back pain with emphasis on imaging. Annals of internal medicine 2002. 137:586-97. PMID: 12353946. DOI.