Differential for low back pain:
compression fracture herniated nucleus pulposus paraspinal muscular strain/sprain/spasm spinal stenosis spondylosis (degenerative changes of the spine)
spondylolisthesis (forward displacement of a vertebra)
spondylolysis (defect or fracture of the pars interarticularis of the vertebral arch)
connective tissue disease
inflammatory spondyloarthropathy
malignancy
vertebral diskitis/osteomyelitis
referred pain from other conditions (e.g., pancreatitis, pyelonephritis, abdominal aortic aneurysm, nephrolithiasis)
Red flags for low back pain
significant trauma (or minor trauma in older patients with osteoporosis)
major or progressive motor or sensory deficit
new-onset bowel or bladder incontinence or urine retention
loss of anal sphincter tone
saddle anesthesia
history of cancer that can metastasize to bone
pain increased or unrelieved by rest
pain with unexplained weight loss
prolonged history of glucocorticoid use
Intravenous drug use
immunosuppression
severe pain or history of spine surgery
fevers
When to image low back pain
When red flags show up.
The most appropriate choice and sequence of imaging studies (radiography, MRI, and/or CT) depends on the particular diagnoses that the clinician wishes to confirm or exclude
