Low back pain symptoms

Back pain only
(about 93% of total patients)

Sciatica
(4% of total patients)

Possible stenosis:
back and leg pain received by sitting: usually seen in older adults
(3% of total patients)

Stop

ESR

If 2 risk factors or ESR >20 mm/hr, obtain radiographs

If radiographs or ESR abnormal, consider further imaging, usually MRI

Urgent consultation and CT or MRI to evaluate for cord or cauda equina compression

CT or MRI

Consider discectomy

MRI, CT, or electrodiagnosis

Consider laminectomy

Consider laminectomy

END

Simple back pain:
Age <50; no symptoms of systemic disease; no history of cancer; no neurologic deficit; >0.99 likelihood of musculoskeletal cause

Complicated back pain:
Age 50; systemic signs, symptoms, or risk factors of fever, weight loss, history of cancer, hematuria, adenopathy, or IV drug use; 1%-10% probability of systemic disease, depending on the findings; 95% of patients have musculoligamentous pain

Radiculopathy:
Signs and symptoms of radiculopathy without bladder Involvement or bilateral findings (99%)

Urgent situations:
Acute radiculopathy with urinary retention, saddle anesthesia, or bilateral neurologic findings (1%)

Tolerable symptoms without neurologic deficit

Intolerable symptoms or neurologic deficits

No diagnostic tests:
conservative therapy for 6 wk

Improved

Not Improved

Conservative care for 6 wk unless neurologic deficit progresses

Improved

Not improved

Treatment of Symptoms

Improved

Not improved