Low back pain differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Diagnosing the cause of back pain can be difficult, because many diseases can cause this symptom. Most frequently the cause is benign and/or self-limiting, but more serious causes may require urgent intervention. Acute back pain is a severe, persistent back pain of sudden onset that is likely to require surgical intervention to treat its cause. The following table summarizes differential diagnosis for back pain.
Differential Diagnosis of Back Pain
| Classification of pain in the back based on etiology | Diease | Clinical Manifestation | Diagnosis | Comments | ||
|---|---|---|---|---|---|---|
| Symptoms | Signs | Lab findings | Imaging | |||
| Vascular | Aortic dissection | |||||
| Aortic aneurysm
- Abdominal aneurysm - Thoracic aneurysm |
||||||
| Neurological | Spinal cord compression
- Thoracic spine - Lumbar spine |
|||||
| Cauda equina compression | ||||||
| Radiculopathy | ||||||
| Epidural abscess | ||||||
| Bone | Discitis | |||||
| Vertebral osteomyelitis | ||||||
| Septic sacroilitis | ||||||
| Vertebral compression fracture | ||||||
| Spinal stenosis | ||||||
| Osteoarthritis | ||||||
| Ankylosing spondylitis | ||||||
| Chronic recurrent focal osteomyelitis | ||||||
| Scoliosis | ||||||
| Hyperkyphosis | ||||||
| Spondylosis
- Spondylolisthesis |
||||||
| Scheuermann (juvenile) kyphosis | ||||||
| Disc herniation | ||||||
| Sacroiliac joint dysfunction | ||||||
| Bertolotti's syndrome (Lumbosacral transitional vertebrae) | ||||||
| Non-spinal infections | Pyomyositis | |||||
| Pyelonephritis | ||||||
| Nephrolithiasis | ||||||
| Pelvic inflammatory disease | ||||||
| Pneumonia | ||||||
| Endocarditis | ||||||
| Myalgia | ||||||
| Cystitis | ||||||
| Cholelithiasis | ||||||
| Appendicitis | ||||||
| Inflammatory arthritis | ||||||
| Tumors | Osteoid osteoma | |||||
| Osteoblastoma | ||||||
| Ewing sarcoma | ||||||
| Osteosarcoma | ||||||
| Lymphoma | ||||||
| Prostate cancer | ||||||
| Neurofibroma | ||||||
| Leukemia | ||||||
| Langerhan cell histocytosis (eosinophilic granulomas) | ||||||
| Muscle-related | Pyriformis syndrome | |||||
| Miscellaneous | Herpes zoster | |||||
| Sickle cell anemia | ||||||
| Syringomyelia | ||||||
| Ureteropelvic junction obstruction | ||||||
| Chronic pain syndrome | ||||||
| Psychologic distress | ||||||