Back pain differential diagnosis: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
| Line 44: | Line 44: | ||
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Classification of pain in the back based on etiology | ! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Classification of pain in the back based on etiology | ||
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diease | ! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diease | ||
! colspan=" | ! colspan="14" style="background:#4479BA; color: #FFFFFF;" align="center" |Clinical Manifestation | ||
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diagnosis | ! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diagnosis | ||
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Comments | ! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Comments | ||
|- | |- | ||
! colspan=" | ! colspan="10" style="background:#4479BA; color: #FFFFFF;" align="center" |Symptoms | ||
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |Signs | ! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |Signs | ||
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Lab findings | ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Lab findings | ||
| Line 61: | Line 61: | ||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Headache | ! style="background:#4479BA; color: #FFFFFF;" align="center" |Headache | ||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea and vomiting | ! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea and vomiting | ||
!Syncopy | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss | ! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss | ||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Motor weakness | ! style="background:#4479BA; color: #FFFFFF;" align="center" |Motor weakness | ||
| Line 71: | Line 72: | ||
|Severe acute and rarely, chronic | |Severe acute and rarely, chronic | ||
|Minutes to hours | |Minutes to hours | ||
| | |Sharp and knife-like, also tearing or ripping | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | | - | ||
|<nowiki>-</nowiki> | |||
| | | | ||
| | | | ||
| Line 93: | Line 95: | ||
|Acute | |Acute | ||
|Minutes to hours | |Minutes to hours | ||
| | |||
| | | | ||
| | | | ||
| Line 111: | Line 114: | ||
|Chronic | |Chronic | ||
|Variable | |Variable | ||
| | |||
| | | | ||
| | | | ||
| Line 129: | Line 133: | ||
|Acute | |Acute | ||
|Minutes to hours | |Minutes to hours | ||
| | |||
| | | | ||
| | | | ||
| Line 147: | Line 152: | ||
|Acute | |Acute | ||
|Minutes to hours | |Minutes to hours | ||
| | |||
| | | | ||
| | | | ||
| Line 165: | Line 171: | ||
|Acute or subacute | |Acute or subacute | ||
|Minutes to hours | |Minutes to hours | ||
| | |||
| | | | ||
| | | | ||
| Line 183: | Line 190: | ||
|Acute | |Acute | ||
|Minutes to hours | |Minutes to hours | ||
| | |||
| | | | ||
| | | | ||
| Line 202: | Line 210: | ||
|Acute | |Acute | ||
|Hours | |Hours | ||
| | |||
| | | | ||
| | | | ||
| Line 220: | Line 229: | ||
|Acute | |Acute | ||
|Hours | |Hours | ||
| | |||
| | | | ||
| | | | ||
| Line 238: | Line 248: | ||
|Acute | |Acute | ||
|Variable | |Variable | ||
| | |||
| | | | ||
| | | | ||
| Line 256: | Line 267: | ||
|Acute | |Acute | ||
|Variable | |Variable | ||
| | |||
| | | | ||
| | | | ||
| Line 274: | Line 286: | ||
|Acute | |Acute | ||
|Minutes to hours | |Minutes to hours | ||
| | |||
| | | | ||
| | | | ||
| Line 296: | Line 309: | ||
|Acute | |Acute | ||
|Minutes to hours | |Minutes to hours | ||
| | |||
| | | | ||
| | | | ||
| Line 315: | Line 329: | ||
|Subacute or chronic | |Subacute or chronic | ||
|Years | |Years | ||
| | |||
| | | | ||
| | | | ||
| Line 333: | Line 348: | ||
|Chronic | |Chronic | ||
|Years | |Years | ||
| | |||
| | | | ||
| | | | ||
| Line 351: | Line 367: | ||
|Chronic | |Chronic | ||
|Years | |Years | ||
| | |||
| | | | ||
| | | | ||
| Line 369: | Line 386: | ||
|Acute | |Acute | ||
|Minutes to hours | |Minutes to hours | ||
| | |||
| | | | ||
| | | | ||
| Line 387: | Line 405: | ||
|Subacute or chronic | |Subacute or chronic | ||
|Years | |Years | ||
| | |||
| | | | ||
| | | | ||
| Line 405: | Line 424: | ||
|Acute | |Acute | ||
|Minutes to hours | |Minutes to hours | ||
| | |||
| | | | ||
| | | | ||
| Line 423: | Line 443: | ||
|Chronic | |Chronic | ||
|Years | |Years | ||
| | |||
| | | | ||
| | | | ||
| Line 441: | Line 462: | ||
|Chronic | |Chronic | ||
|Years | |Years | ||
| | |||
| | | | ||
| | | | ||
| Line 459: | Line 481: | ||
|Chronic | |Chronic | ||
|Years | |Years | ||
| | |||
| | | | ||
| | | | ||
| Line 477: | Line 500: | ||
|Chronic | |Chronic | ||
|Years | |Years | ||
| | |||
| | | | ||
| | | | ||
| Line 495: | Line 519: | ||
|Acute or chronic | |Acute or chronic | ||
|Variable | |Variable | ||
| | |||
| | | | ||
| | | | ||
| Line 513: | Line 538: | ||
|Chronic | |Chronic | ||
|Years | |Years | ||
| | |||
| | | | ||
| | | | ||
| Line 531: | Line 557: | ||
|Chronic | |Chronic | ||
|Years | |Years | ||
| | |||
| | | | ||
| | | | ||
| Line 548: | Line 575: | ||
![[Spinal stenosis]] | ![[Spinal stenosis]] | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 566: | Line 594: | ||
![[Spondylosis]] | ![[Spondylosis]] | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 584: | Line 613: | ||
![[Compression fracture|Vertebral compression fracture]] | ![[Compression fracture|Vertebral compression fracture]] | ||
|Acute | |Acute | ||
| | |||
| | | | ||
| | | | ||
| Line 602: | Line 632: | ||
![[Vertebral osteomyelitis]] | ![[Vertebral osteomyelitis]] | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 621: | Line 652: | ||
![[Appendicitis]] | ![[Appendicitis]] | ||
|Acute | |Acute | ||
| | |||
| | | | ||
| | | | ||
| Line 639: | Line 671: | ||
![[Endocarditis]] | ![[Endocarditis]] | ||
|Acute or subacute | |Acute or subacute | ||
| | |||
| | | | ||
| | | | ||
| Line 658: | Line 691: | ||
|Acute or subacute | |Acute or subacute | ||
|Minutes or hours | |Minutes or hours | ||
| | |||
| | | | ||
| | | | ||
| Line 675: | Line 709: | ||
![[Cystitis]] | ![[Cystitis]] | ||
|Acute | |Acute | ||
| | |||
| | | | ||
| | | | ||
| Line 693: | Line 728: | ||
![[Myalgia]] | ![[Myalgia]] | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 711: | Line 747: | ||
![[Kidney stone|Nephrolithiasis]] | ![[Kidney stone|Nephrolithiasis]] | ||
|Acute | |Acute | ||
| | |||
| | | | ||
| | | | ||
| Line 730: | Line 767: | ||
|Acute or chronic | |Acute or chronic | ||
|Variable | |Variable | ||
! | |||
! | ! | ||
! | ! | ||
| Line 747: | Line 785: | ||
![[Pyelonephritis]] | ![[Pyelonephritis]] | ||
|Acute or chronic | |Acute or chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 765: | Line 804: | ||
![[Pelvic inflammatory disease]] | ![[Pelvic inflammatory disease]] | ||
|Acute or chronic | |Acute or chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 784: | Line 824: | ||
|Acute or chronic | |Acute or chronic | ||
|Variable | |Variable | ||
| | |||
| | | | ||
| | | | ||
| Line 801: | Line 842: | ||
![[Pyomyositis]] | ![[Pyomyositis]] | ||
|Acute or chronic | |Acute or chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 820: | Line 862: | ||
|Chronic | |Chronic | ||
|Years | |Years | ||
| | |||
| | | | ||
| | | | ||
| Line 838: | Line 881: | ||
![[Ewing's sarcoma]] | ![[Ewing's sarcoma]] | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 856: | Line 900: | ||
![[Langerhans cell histiocytosis]] (eosinophilic granulomas) | ![[Langerhans cell histiocytosis]] (eosinophilic granulomas) | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 874: | Line 919: | ||
![[Leukemia]] | ![[Leukemia]] | ||
|Acute or chronic | |Acute or chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 892: | Line 938: | ||
![[Lymphoma]] | ![[Lymphoma]] | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 910: | Line 957: | ||
![[Neurofibroma]] | ![[Neurofibroma]] | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 928: | Line 976: | ||
![[Osteoblastoma]] | ![[Osteoblastoma]] | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 946: | Line 995: | ||
![[Osteoid osteoma]] | ![[Osteoid osteoma]] | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 964: | Line 1,014: | ||
![[Osteosarcoma]] | ![[Osteosarcoma]] | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 982: | Line 1,033: | ||
![[Prostate cancer]] | ![[Prostate cancer]] | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 1,001: | Line 1,053: | ||
![[Abnormal posturing]] | ![[Abnormal posturing]] | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 1,019: | Line 1,072: | ||
![[Muscle spasm]] | ![[Muscle spasm]] | ||
|Acute | |Acute | ||
| | |||
| | | | ||
| | | | ||
| Line 1,037: | Line 1,091: | ||
!Pyriformis syndrome | !Pyriformis syndrome | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 1,056: | Line 1,111: | ||
![[Chronic fatigue syndrome]] | ![[Chronic fatigue syndrome]] | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 1,074: | Line 1,130: | ||
![[Depression]] | ![[Depression]] | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 1,093: | Line 1,150: | ||
|Acute or chronic | |Acute or chronic | ||
|Variable | |Variable | ||
| | |||
| | | | ||
| | | | ||
| Line 1,110: | Line 1,168: | ||
![[Pregnancy]] | ![[Pregnancy]] | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 1,128: | Line 1,187: | ||
![[Premenstrual syndrome]] | ![[Premenstrual syndrome]] | ||
|Acute | |Acute | ||
| | |||
| | | | ||
| | | | ||
| Line 1,146: | Line 1,206: | ||
![[Sickle cell anemia]] | ![[Sickle cell anemia]] | ||
|Acute or chronic | |Acute or chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 1,164: | Line 1,225: | ||
![[Syringomyelia]] | ![[Syringomyelia]] | ||
|Chronic | |Chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 1,182: | Line 1,244: | ||
![[Physical trauma|Trauma]] | ![[Physical trauma|Trauma]] | ||
|Acute or chronic | |Acute or chronic | ||
| | |||
| | | | ||
| | | | ||
| Line 1,200: | Line 1,263: | ||
![[Ureteropelvic junction obstruction]] | ![[Ureteropelvic junction obstruction]] | ||
|Acute | |Acute | ||
| | |||
| | | | ||
| | | | ||
Revision as of 14:51, 28 March 2018
|
Back pain Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Lecture |
|
Case Studies |
|
Back pain differential diagnosis On the Web |
|
American Roentgen Ray Society Images of Back pain differential diagnosis |
|
Risk calculators and risk factors for Back pain differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
An expert algorithm to assist in the diagnosis of back pain can be found here
Overview
There are several life-threatening causes of back pain which need to be evaluated for first, which include; spinal cord or cauda equina compression, aortic dissection, aortic aneurysm, vertebral osteomyelitis, epidural abscess, and metastatic cancer. The other possible causes of back pain can be evaluated for by carefully assessing the nature of the pain, and obtaining a thorough patient history.
Differential Diagnosis
Life Threatening Causes
Life threatening diseases to exclude immediately include:[1][2][3][4][2][3][5][6][7][8][9][10][11][12][13][14][15][16][17]
- Abdominal aortic aneurysm
- Adrenal hemorrhage
- Aortic dissection
- Arachnoiditis
- Cauda equina syndrome
- Cervical fracture
- Chronic stable angina
- Epidural abscess
- Pulmonary embolism
- Retroperitoneal hematoma
- Traumatic aortic rupture
- Vertebral fractures
Common Causes
- Abnormal posturing
- Degenerative disc disease
- Depression
- Osteoarthritis
- Pregnancy
- Premenstrual syndrome
- Sciatica
- Spinal disc herniation
- Spinal stenosis
- Trauma
Differential Diagnosis of Back Pain
| Classification of pain in the back based on etiology | Diease | Clinical Manifestation | Diagnosis | Comments | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Symptoms | Signs | Lab findings | Imaging | |||||||||||||||
| Onset | Duration | Quality of pain | Stiffness | Fever | Rigors and chills | Headache | Nausea and vomiting | Syncopy | Weight loss | Motor weakness | Sensory deficit | Bowel or bladder dysfunction | Horner's syndrome | |||||
| Vascular | Aortic dissection | Severe acute and rarely, chronic | Minutes to hours | Sharp and knife-like, also tearing or ripping | - | - | - | - | ||||||||||
| Aortic aneurysm
rupture - Abdominal aortic aneurysm |
Acute | Minutes to hours | ||||||||||||||||
| Chronic stable angina | Chronic | Variable | ||||||||||||||||
| Pulmonary embolism | Acute | Minutes to hours | ||||||||||||||||
| Traumatic aortic rupture | Acute | Minutes to hours | ||||||||||||||||
| Retroperitoneal hematoma | Acute or subacute | Minutes to hours | ||||||||||||||||
| Waterhouse-Friderichsen syndrome | Acute | Minutes to hours | ||||||||||||||||
| Neurological | Arachnoiditis | Acute | Hours | |||||||||||||||
| Cauda equina syndrome | Acute | Hours | ||||||||||||||||
| Epidural abscess | Acute | Variable | ||||||||||||||||
| Radiculopathy | Acute | Variable | ||||||||||||||||
| Sciatica | Acute | Minutes to hours | ||||||||||||||||
| Spinal cord compression
- Thoracic spine - Lumbar spine |
Acute | Minutes to hours | ||||||||||||||||
| Bone | Ankylosing spondylitis | Subacute or chronic | Years | |||||||||||||||
| Bertolotti's syndrome (Lumbosacral transitional vertebrae) | Chronic | Years | ||||||||||||||||
| Chronic recurrent focal osteomyelitis | Chronic | Years | ||||||||||||||||
| Cervical fracture | Acute | Minutes to hours | ||||||||||||||||
| Degenerative disc disease | Subacute or chronic | Years | ||||||||||||||||
| Disc herniation | Acute | Minutes to hours | ||||||||||||||||
| Discitis | Chronic | Years | ||||||||||||||||
| Hyperkyphosis | Chronic | Years | ||||||||||||||||
| Osteoarthritis | Chronic | Years | ||||||||||||||||
| Sacroiliac joint dysfunction | Chronic | Years | ||||||||||||||||
| Sacroilitis | Acute or chronic | Variable | ||||||||||||||||
| Scheuermann (juvenile) kyphosis | Chronic | Years | ||||||||||||||||
| Scoliosis | Chronic | Years | ||||||||||||||||
| Spinal stenosis | Chronic | |||||||||||||||||
| Spondylosis | Chronic | |||||||||||||||||
| Vertebral compression fracture | Acute | |||||||||||||||||
| Vertebral osteomyelitis | Chronic | |||||||||||||||||
| Non-spinal infections | Appendicitis | Acute | ||||||||||||||||
| Endocarditis | Acute or subacute | |||||||||||||||||
| Cholelithiasis | Acute or subacute | Minutes or hours | ||||||||||||||||
| Cystitis | Acute | |||||||||||||||||
| Myalgia | Chronic | |||||||||||||||||
| Nephrolithiasis | Acute | |||||||||||||||||
| Pancreatitis | Acute or chronic | Variable | ||||||||||||||||
| Pyelonephritis | Acute or chronic | |||||||||||||||||
| Pelvic inflammatory disease | Acute or chronic | |||||||||||||||||
| Pneumonia | Acute or chronic | Variable | ||||||||||||||||
| Pyomyositis | Acute or chronic | |||||||||||||||||
| Rheumatoid arthritis | Chronic | Years | ||||||||||||||||
| Tumors | Ewing's sarcoma | Chronic | ||||||||||||||||
| Langerhans cell histiocytosis (eosinophilic granulomas) | Chronic | |||||||||||||||||
| Leukemia | Acute or chronic | |||||||||||||||||
| Lymphoma | Chronic | |||||||||||||||||
| Neurofibroma | Chronic | |||||||||||||||||
| Osteoblastoma | Chronic | |||||||||||||||||
| Osteoid osteoma | Chronic | |||||||||||||||||
| Osteosarcoma | Chronic | |||||||||||||||||
| Prostate cancer | Chronic | |||||||||||||||||
| Muscle-related | Abnormal posturing | Chronic | ||||||||||||||||
| Muscle spasm | Acute | |||||||||||||||||
| Pyriformis syndrome | Chronic | |||||||||||||||||
| Miscellaneous | Chronic fatigue syndrome | Chronic | ||||||||||||||||
| Depression | Chronic | |||||||||||||||||
| Herpes zoster | Acute or chronic | Variable | ||||||||||||||||
| Pregnancy | Chronic | |||||||||||||||||
| Premenstrual syndrome | Acute | |||||||||||||||||
| Sickle cell anemia | Acute or chronic | |||||||||||||||||
| Syringomyelia | Chronic | |||||||||||||||||
| Trauma | Acute or chronic | |||||||||||||||||
| Ureteropelvic junction obstruction | Acute | |||||||||||||||||
References
- ↑ Chou R, Qaseem A, Owens DK, Shekelle P (February 2011). "Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians". Ann. Intern. Med. 154 (3): 181–9. doi:10.7326/0003-4819-154-3-201102010-00008. PMID 21282698.
- ↑ 2.0 2.1 Schiff D, O'Neill BP, Suman VJ (August 1997). "Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach". Neurology. 49 (2): 452–6. PMID 9270576.
- ↑ 3.0 3.1 Deyo RA, Diehl AK (1988). "Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies". J Gen Intern Med. 3 (3): 230–8. PMID 2967893.
- ↑ Sun JC, Xu T, Chen KF, Qian W, Liu K, Shi JG, Yuan W, Jia LS (April 2014). "Assessment of cauda equina syndrome progression pattern to improve diagnosis". Spine. 39 (7): 596–602. doi:10.1097/BRS.0000000000000079. PMID 24150427.
- ↑ Jarvik JG, Deyo RA (October 2002). "Diagnostic evaluation of low back pain with emphasis on imaging". Ann. Intern. Med. 137 (7): 586–97. PMID 12353946.
- ↑ Underwood MR, Dawes P (November 1995). "Inflammatory back pain in primary care". Br. J. Rheumatol. 34 (11): 1074–7. PMID 8542211.
- ↑ "Acute low back problems in adults: assessment and treatment. Agency for Health Care Policy and Research". Clin Pract Guidel Quick Ref Guide Clin (14): iii–iv, 1–25. December 1994. PMID 7987418.
- ↑ Ropper AH, Zafonte RD (March 2015). "Sciatica". N. Engl. J. Med. 372 (13): 1240–8. doi:10.1056/NEJMra1410151. PMID 25806916.
- ↑ Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, Fye M, Welch WC (April 2015). "Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial". Ann. Intern. Med. 162 (7): 465–73. doi:10.7326/M14-1420. PMID 25844995.
- ↑ Papadopoulos EC, Khan SN (January 2004). "Piriformis syndrome and low back pain: a new classification and review of the literature". Orthop. Clin. North Am. 35 (1): 65–71. doi:10.1016/S0030-5898(03)00105-6. PMID 15062719.
- ↑ Hopayian K, Song F, Riera R, Sambandan S (December 2010). "The clinical features of the piriformis syndrome: a systematic review". Eur Spine J. 19 (12): 2095–109. doi:10.1007/s00586-010-1504-9. PMC 2997212. PMID 20596735.
- ↑ Potter NA, Rothstein JM (November 1985). "Intertester reliability for selected clinical tests of the sacroiliac joint". Phys Ther. 65 (11): 1671–5. PMID 2932746.
- ↑ Russel AS, Maksymowych W, LeClercq S (December 1981). "Clinical examination of the sacroiliac joints: a prospective study". Arthritis Rheum. 24 (12): 1575–7. PMID 7326071.
- ↑ Levangie PK (November 1999). "Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain". Phys Ther. 79 (11): 1043–57. PMID 10534797.
- ↑ Riddle DL, Freburger JK (August 2002). "Evaluation of the presence of sacroiliac joint region dysfunction using a combination of tests: a multicenter intertester reliability study". Phys Ther. 82 (8): 772–81. PMID 12147007.
- ↑ Irwin RW, Watson T, Minick RP, Ambrosius WT (January 2007). "Age, body mass index, and gender differences in sacroiliac joint pathology". Am J Phys Med Rehabil. 86 (1): 37–44. PMID 17304687.
- ↑ Jancuska JM, Spivak JM, Bendo JA (2015). "A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome". Int J Spine Surg. 9: 42. doi:10.14444/2042. PMC 4603258. PMID 26484005.