Algorithm for Management of Low Back Pain - Flowchart
Algorithm for Management of Low Back Pain - Flowchart Spinal Stenosis, Lumbar Spinal Stenosis, Lumbar
«Flowchart»

If there is concern for...

If there is concern for...

If there is concern for...

Fracture

Fracture

Fracture

Cauda equina syndrome

Cauda equina syndrome

Cauda equina syndrome

Spinal infection

Spinal infection

Spinal infection

Vertebral malignancy

Vertebral malignancy

Vertebral malignancy

Simple radiculopathy

Simple radiculopathy

Simple radiculopathy

None of above

None of above

None of above

Then...

Outpatient workup for “musculoskeletal back pain”

Then...

Outpatient workup for “musculoskeletal back pain”

Then...

Outpatient workup for “musculoskeletal back pain”

Then...

Plain radiograph, emergent MRI

Then...

Plain radiograph, emergent MRI

Then...

Plain radiograph, emergent MRI

Then...

Plain radiograph

Then...

Plain radiograph

Then...

Plain radiograph

Then...

Outpatient workup for herniated disk

Then...

Outpatient workup for herniated disk

Then...

Outpatient workup for herniated disk

End

End

End

Emergent MRI

Emergent MRI

Emergent MRI

Then...

Plain radiograph, lab

Then...

Plain radiograph, lab

Then...

Plain radiograph, lab

Abnormal

Abnormal

Abnormal

Normal

Normal

Normal

Outpatient workup

Outpatient workup

Outpatient workup

Emergent MRI

Emergent MRI

Emergent MRI

Low suspicion

Low suspicion

Low suspicion

High suspicion

High suspicion

High suspicion

Then...

Known cancer history?

Then...

Known cancer history?

Then...

Known cancer history?

Yes

Yes

Yes

No

No

No

Plain radiograph, lab

Plain radiograph, lab

Plain radiograph, lab

Plain radiograph, lab

Plain radiograph, lab

Plain radiograph, lab

Evidence of radiculopathy?

Evidence of radiculopathy?

Evidence of radiculopathy?

Yes

Yes

Yes

No

No

No

Normal: Emergent MRI

Normal: Emergent MRI

Normal: Emergent MRI

Abnormal: Emergent MRI

Abnormal: Emergent MRI

Abnormal: Emergent MRI

Normal: Outpatient MRI (or CT)

Normal: Outpatient MRI (or CT)

Normal: Outpatient MRI (or CT)

Abnormal: Outpatient MRI (or CT)

Abnormal: Outpatient MRI (or CT)

Abnormal: Outpatient MRI (or CT)

Plain radiograph, lab

Plain radiograph, lab

Plain radiograph, lab

Plain radiograph, lab

Plain radiograph, lab

Plain radiograph, lab

Evidence of radiculopathy?

Evidence of radiculopathy?

Evidence of radiculopathy?

Yes

Yes

Yes

No

No

No

Normal: Outpatient workup

Normal: Outpatient workup

Normal: Outpatient workup

Abnormal: Emergent MRI

Abnormal: Emergent MRI

Abnormal: Emergent MRI

Normal: Outpatient workup

Normal: Outpatient workup

Normal: Outpatient workup

Abnormal: Outpatient MRI (or CT)

Abnormal: Outpatient MRI (or CT)

Abnormal: Outpatient MRI (or CT)