Nevertheless, serious causes (‘red flags’) have to be
excluded.
TABLE 1
Differential diagnosis of low back pain
Spinal disorders Spinal disorders
Lumbar strain or sprain Neoplasia Pelvic organs (for
example, prostatitis,
endometriosis, pelvic
inflammatory disease)
Degenerative disease Infection
Spondylosis Inflammatory arthritis Vascular disease (for
example, abdominal
aortic aneurysm,
aorto-iliac disease)
Spondylolisthesis Paget’s disease Gastrointestinal disease
(for example,
pancreatitis,
cholecystitis)
Intervertebral disc
herniation Osteochondrosis
Spinal stenosis
Fracture
Congenital disease
(kyphosis, scoliosis)
Internal disc disruption
Adapted from reference 22
Visceral disorders
Renal disease
Symptomatology and differential diagnosis
The differential diagnosis of low back pain is broad
and includes both mechanical and nonmechanical
causes. Among the mechanical causes, lumbar
strains/sprain, degenerative disease of the discs/facet
joints, spondylosis/spondylolisthesis, disc herniation/
disruption, fractures and congenital diseases must
be considered. Non-mechanical conditions include
spinal disorders (for example, malignancies,
infection, inflammatory arthritis) and visceral
disorders (including prostatitis, endometriosis and
pelvic inflammatory disease, as well as kidney,
vascular, and gastrointestinal disease) (Table 1). 10
Currently the diagnosis is primarily based on
anamnesis and clinical judgment. A thorough
clinical assessment of the low back pain constitutes
an important step to reassure patients and manage
the condition, and a complete medical history may
help speed up the diagnosis. This assessment should
be accompanied by a thorough physical
examination, which might include sensory tests (for
example, response to pressure, cold/heat sensation,
and vibration) and a psychosocial evaluation. Keep
in mind that there is usually only a weak agreement
between the results of the physical examination and
the subjective reporting of the severity of pain and
disability. However, this approach is not too
time-consuming and can ensure that serious ‘red
flags’ (that is, symptoms that could indicate
potentially serious conditions, warranting
immediate intervention, such as fever, urinary or
faecal incontinence, bilateral lower extremity
weakness or numbness, or progressive neurologic
deficits) are not being missed. 2 Although the
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