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==Differential Diagnosis==
==Differential Diagnosis==
*5 life threatening diseases to exclude immediately:<ref name="pmid21282698">{{cite journal |vauthors=Chou R, Qaseem A, Owens DK, Shekelle P |title=Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians |journal=Ann. Intern. Med. |volume=154 |issue=3 |pages=181–9 |date=February 2011 |pmid=21282698 |doi=10.7326/0003-4819-154-3-201102010-00008 |url=}}</ref><ref name="pmid9270576">{{cite journal |vauthors=Schiff D, O'Neill BP, Suman VJ |title=Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach |journal=Neurology |volume=49 |issue=2 |pages=452–6 |date=August 1997 |pmid=9270576 |doi= |url=}}</ref><ref name="pmid2967893">{{cite journal |vauthors=Deyo RA, Diehl AK |title=Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies |journal=J Gen Intern Med |volume=3 |issue=3 |pages=230–8 |date=1988 |pmid=2967893 |doi= |url=}}</ref><ref name="pmid24150427">{{cite journal |vauthors=Sun JC, Xu T, Chen KF, Qian W, Liu K, Shi JG, Yuan W, Jia LS |title=Assessment of cauda equina syndrome progression pattern to improve diagnosis |journal=Spine |volume=39 |issue=7 |pages=596–602 |date=April 2014 |pmid=24150427 |doi=10.1097/BRS.0000000000000079 |url=}}</ref><ref name="pmid9270576">{{cite journal |vauthors=Schiff D, O'Neill BP, Suman VJ |title=Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach |journal=Neurology |volume=49 |issue=2 |pages=452–6 |date=August 1997 |pmid=9270576 |doi= |url=}}</ref><ref name="pmid2967893">{{cite journal |vauthors=Deyo RA, Diehl AK |title=Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies |journal=J Gen Intern Med |volume=3 |issue=3 |pages=230–8 |date=1988 |pmid=2967893 |doi= |url=}}</ref><ref name="pmid12353946">{{cite journal |vauthors=Jarvik JG, Deyo RA |title=Diagnostic evaluation of low back pain with emphasis on imaging |journal=Ann. Intern. Med. |volume=137 |issue=7 |pages=586–97 |date=October 2002 |pmid=12353946 |doi= |url=}}</ref><ref name="pmid8542211">{{cite journal |vauthors=Underwood MR, Dawes P |title=Inflammatory back pain in primary care |journal=Br. J. Rheumatol. |volume=34 |issue=11 |pages=1074–7 |date=November 1995 |pmid=8542211 |doi= |url=}}</ref><ref name="pmid7987418">{{cite journal |vauthors= |title=Acute low back problems in adults: assessment and treatment. Agency for Health Care Policy and Research |journal=Clin Pract Guidel Quick Ref Guide Clin |volume= |issue=14 |pages=iii–iv, 1–25 |date=December 1994 |pmid=7987418 |doi= |url=}}</ref><ref name="pmid25806916">{{cite journal |vauthors=Ropper AH, Zafonte RD |title=Sciatica |journal=N. Engl. J. Med. |volume=372 |issue=13 |pages=1240–8 |date=March 2015 |pmid=25806916 |doi=10.1056/NEJMra1410151 |url=}}</ref><ref name="pmid25844995">{{cite journal |vauthors=Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, Fye M, Welch WC |title=Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial |journal=Ann. Intern. Med. |volume=162 |issue=7 |pages=465–73 |date=April 2015 |pmid=25844995 |doi=10.7326/M14-1420 |url=}}</ref><ref name="pmid15062719">{{cite journal |vauthors=Papadopoulos EC, Khan SN |title=Piriformis syndrome and low back pain: a new classification and review of the literature |journal=Orthop. Clin. North Am. |volume=35 |issue=1 |pages=65–71 |date=January 2004 |pmid=15062719 |doi=10.1016/S0030-5898(03)00105-6 |url=}}</ref><ref name="pmid20596735">{{cite journal |vauthors=Hopayian K, Song F, Riera R, Sambandan S |title=The clinical features of the piriformis syndrome: a systematic review |journal=Eur Spine J |volume=19 |issue=12 |pages=2095–109 |date=December 2010 |pmid=20596735 |pmc=2997212 |doi=10.1007/s00586-010-1504-9 |url=}}</ref><ref name="pmid2932746">{{cite journal |vauthors=Potter NA, Rothstein JM |title=Intertester reliability for selected clinical tests of the sacroiliac joint |journal=Phys Ther |volume=65 |issue=11 |pages=1671–5 |date=November 1985 |pmid=2932746 |doi= |url=}}</ref><ref name="pmid7326071">{{cite journal |vauthors=Russel AS, Maksymowych W, LeClercq S |title=Clinical examination of the sacroiliac joints: a prospective study |journal=Arthritis Rheum. |volume=24 |issue=12 |pages=1575–7 |date=December 1981 |pmid=7326071 |doi= |url=}}</ref><ref name="pmid10534797">{{cite journal |vauthors=Levangie PK |title=Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain |journal=Phys Ther |volume=79 |issue=11 |pages=1043–57 |date=November 1999 |pmid=10534797 |doi= |url=}}</ref><ref name="pmid12147007">{{cite journal |vauthors=Riddle DL, Freburger JK |title=Evaluation of the presence of sacroiliac joint region dysfunction using a combination of tests: a multicenter intertester reliability study |journal=Phys Ther |volume=82 |issue=8 |pages=772–81 |date=August 2002 |pmid=12147007 |doi= |url=}}</ref><ref name="pmid17304687">{{cite journal |vauthors=Irwin RW, Watson T, Minick RP, Ambrosius WT |title=Age, body mass index, and gender differences in sacroiliac joint pathology |journal=Am J Phys Med Rehabil |volume=86 |issue=1 |pages=37–44 |date=January 2007 |pmid=17304687 |doi= |url=}}</ref><ref name="pmid26484005">{{cite journal |vauthors=Jancuska JM, Spivak JM, Bendo JA |title=A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome |journal=Int J Spine Surg |volume=9 |issue= |pages=42 |date=2015 |pmid=26484005 |pmc=4603258 |doi=10.14444/2042 |url=}}</ref>
*5 life threatening diseases to exclude immediately:<ref name="pmid21282698">{{cite journal |vauthors=Chou R, Qaseem A, Owens DK, Shekelle P |title=Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians |journal=Ann. Intern. Med. |volume=154 |issue=3 |pages=181–9 |date=February 2011 |pmid=21282698 |doi=10.7326/0003-4819-154-3-201102010-00008 |url=}}</ref><ref name="pmid9270576">{{cite journal |vauthors=Schiff D, O'Neill BP, Suman VJ |title=Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach |journal=Neurology |volume=49 |issue=2 |pages=452–6 |date=August 1997 |pmid=9270576 |doi= |url=}}</ref><ref name="pmid2967893">{{cite journal |vauthors=Deyo RA, Diehl AK |title=Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies |journal=J Gen Intern Med |volume=3 |issue=3 |pages=230–8 |date=1988 |pmid=2967893 |doi= |url=}}</ref><ref name="pmid24150427">{{cite journal |vauthors=Sun JC, Xu T, Chen KF, Qian W, Liu K, Shi JG, Yuan W, Jia LS |title=Assessment of cauda equina syndrome progression pattern to improve diagnosis |journal=Spine |volume=39 |issue=7 |pages=596–602 |date=April 2014 |pmid=24150427 |doi=10.1097/BRS.0000000000000079 |url=}}</ref><ref name="pmid9270576">{{cite journal |vauthors=Schiff D, O'Neill BP, Suman VJ |title=Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach |journal=Neurology |volume=49 |issue=2 |pages=452–6 |date=August 1997 |pmid=9270576 |doi= |url=}}</ref><ref name="pmid2967893">{{cite journal |vauthors=Deyo RA, Diehl AK |title=Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies |journal=J Gen Intern Med |volume=3 |issue=3 |pages=230–8 |date=1988 |pmid=2967893 |doi= |url=}}</ref><ref name="pmid12353946">{{cite journal |vauthors=Jarvik JG, Deyo RA |title=Diagnostic evaluation of low back pain with emphasis on imaging |journal=Ann. Intern. Med. |volume=137 |issue=7 |pages=586–97 |date=October 2002 |pmid=12353946 |doi= |url=}}</ref><ref name="pmid8542211">{{cite journal |vauthors=Underwood MR, Dawes P |title=Inflammatory back pain in primary care |journal=Br. J. Rheumatol. |volume=34 |issue=11 |pages=1074–7 |date=November 1995 |pmid=8542211 |doi= |url=}}</ref><ref name="pmid7987418">{{cite journal |vauthors= |title=Acute low back problems in adults: assessment and treatment. Agency for Health Care Policy and Research |journal=Clin Pract Guidel Quick Ref Guide Clin |volume= |issue=14 |pages=iii–iv, 1–25 |date=December 1994 |pmid=7987418 |doi= |url=}}</ref><ref name="pmid25806916">{{cite journal |vauthors=Ropper AH, Zafonte RD |title=Sciatica |journal=N. Engl. J. Med. |volume=372 |issue=13 |pages=1240–8 |date=March 2015 |pmid=25806916 |doi=10.1056/NEJMra1410151 |url=}}</ref><ref name="pmid25844995">{{cite journal |vauthors=Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, Fye M, Welch WC |title=Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial |journal=Ann. Intern. Med. |volume=162 |issue=7 |pages=465–73 |date=April 2015 |pmid=25844995 |doi=10.7326/M14-1420 |url=}}</ref><ref name="pmid15062719">{{cite journal |vauthors=Papadopoulos EC, Khan SN |title=Piriformis syndrome and low back pain: a new classification and review of the literature |journal=Orthop. Clin. North Am. |volume=35 |issue=1 |pages=65–71 |date=January 2004 |pmid=15062719 |doi=10.1016/S0030-5898(03)00105-6 |url=}}</ref><ref name="pmid20596735">{{cite journal |vauthors=Hopayian K, Song F, Riera R, Sambandan S |title=The clinical features of the piriformis syndrome: a systematic review |journal=Eur Spine J |volume=19 |issue=12 |pages=2095–109 |date=December 2010 |pmid=20596735 |pmc=2997212 |doi=10.1007/s00586-010-1504-9 |url=}}</ref><ref name="pmid2932746">{{cite journal |vauthors=Potter NA, Rothstein JM |title=Intertester reliability for selected clinical tests of the sacroiliac joint |journal=Phys Ther |volume=65 |issue=11 |pages=1671–5 |date=November 1985 |pmid=2932746 |doi= |url=}}</ref><ref name="pmid7326071">{{cite journal |vauthors=Russel AS, Maksymowych W, LeClercq S |title=Clinical examination of the sacroiliac joints: a prospective study |journal=Arthritis Rheum. |volume=24 |issue=12 |pages=1575–7 |date=December 1981 |pmid=7326071 |doi= |url=}}</ref><ref name="pmid10534797">{{cite journal |vauthors=Levangie PK |title=Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain |journal=Phys Ther |volume=79 |issue=11 |pages=1043–57 |date=November 1999 |pmid=10534797 |doi= |url=}}</ref><ref name="pmid12147007">{{cite journal |vauthors=Riddle DL, Freburger JK |title=Evaluation of the presence of sacroiliac joint region dysfunction using a combination of tests: a multicenter intertester reliability study |journal=Phys Ther |volume=82 |issue=8 |pages=772–81 |date=August 2002 |pmid=12147007 |doi= |url=}}</ref><ref name="pmid17304687">{{cite journal |vauthors=Irwin RW, Watson T, Minick RP, Ambrosius WT |title=Age, body mass index, and gender differences in sacroiliac joint pathology |journal=Am J Phys Med Rehabil |volume=86 |issue=1 |pages=37–44 |date=January 2007 |pmid=17304687 |doi= |url=}}</ref><ref name="pmid26484005">{{cite journal |vauthors=Jancuska JM, Spivak JM, Bendo JA |title=A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome |journal=Int J Spine Surg |volume=9 |issue= |pages=42 |date=2015 |pmid=26484005 |pmc=4603258 |doi=10.14444/2042 |url=}}</ref>
**Spinal cord compression
===Life Threatening Causes===
**Cauda equina syndrome
*[[Abdominal aortic aneurysm]]
**[[Aortic dissection]]
 
**Aortic aneurysm
*[[Adrenal hemorrhage]]
**Vertebral osteomyelitis
 
**Epidural abscess
*[[Aortic dissection]]
**Metastatic cancer
 
**Adrenal haemorrhage
*[[Arachnoiditis]]
**Arachnoiditis
 
**Cervical fracture
*[[Cauda equina syndrome]]
**Chronic stable angina
 
**Pulmonary embolism
*[[Cervical fracture]]
**Traumatic aortic rupture
 
**Retro peritoneal hematoma
*[[Chronic stable angina]]
*The frequency of conditions exclusive of the above in a descending order is:
 
**Degenerative disc disease
*[[Epidural abscess]]
**Osteoarthritis
 
**Vertebral compression fracture
*[[Pulmonary embolism]]
**Radiculopathy
 
**Spinal stenosis
*[[Retroperitoneal hematoma]]
**Ankylosing spondylitis
 
**Scoliosis
*[[Traumatic aortic rupture]]
**Hyperkyphosis
 
**Psychologic distress 
*[[Vertebral fractures]]
*The frequency of conditions outside the spine exclusive of the above in a descending order is:
 
**Muscle spasm
===Common Causes===
**Abnormal posture
 
**Premenstrual syndrome
* [[Abnormal posturing]]
**Piriformis syndrome
* [[Degenerative disc disease]]
**Sacroiliac joint dysfunction
* [[Depression]]
**Bertolotti's syndrome (Lumbosacral transitional vertebrae)
* [[Discopathy]]
* [[Osteoarthritis]]
* [[Pregnancy]]
* [[Premenstrual syndrome]]
* [[Sciatica]]
* [[Spinal disc herniation]]
* [[Spinal stenosis]]
* [[Trauma]]


==Differential Diagnosis of Back Pain==
==Differential Diagnosis of Back Pain==

Revision as of 14:23, 22 March 2018

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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]


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

Common Causes

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 Weight loss Motor weakness Sensory deficit Bowel or bladder dysfunction Horner's syndrome
Vascular Aortic dissection
Aortic aneurysm

- Abdominal aneurysm

- Thoracic aneurysm

Adrenal haemorrhgage
Chronic stable angina
Pulmonary embolism
Traumatic aortic rupture
Retroperitoneal hematoma
Neurological Arachnoiditis
Spinal cord compression

- Thoracic spine

- Lumbar spine

Cauda equina syndrome
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

Cervical fracture
Scheuermann (juvenile) kyphosis
Disc herniation
Sacroiliac joint dysfunction
Bertolotti's syndrome (Lumbosacral transitional vertebrae)
Degenerative disc disease
Osteoarthritis
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
Muscle spasm
Abnormal posture
Miscellaneous Trauma
Pregnancy
Premenstrual syndrome
Herpes zoster
Sickle cell anemia
Syringomyelia
Ureteropelvic junction obstruction
Chronic pain syndrome
Psychologic distress

References

  1. ↑ 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. ↑ 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. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ Underwood MR, Dawes P (November 1995). "Inflammatory back pain in primary care". Br. J. Rheumatol. 34 (11): 1074–7. PMID 8542211.
  7. ↑ "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.
  8. ↑ Ropper AH, Zafonte RD (March 2015). "Sciatica". N. Engl. J. Med. 372 (13): 1240–8. doi:10.1056/NEJMra1410151. PMID 25806916.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ Potter NA, Rothstein JM (November 1985). "Intertester reliability for selected clinical tests of the sacroiliac joint". Phys Ther. 65 (11): 1671–5. PMID 2932746.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ 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.


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