Introduction

Pain in the back from the level of the lowest rib down to the gluteal fold, with or without radiation into the legs.

• M/C musculoskeletal condition affecting adults (84% prevalence)
• Leading cause of years lived with disability worldwide
• LBP is a symptom and not a disease

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Classification

• By duration:
  • Acute (< 6 weeks)
  • Sub-chronic (6-12 weeks)
  • Chronic LBP (CLBP) (> 12 weeks)
• By underlying cause:
  • Mechanical
  • Non-mechanical
  • Referred pain

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Aetiology

• Musculoskeletal:
  • Mechanical (including muscle strain, muscle spasm, or osteoarthritis)
  • Herniated nucleus pulposus, herniated disk
  • Spinal stenosis
  • Compression fracture
• Inflammatory:
  • HLA-B27 associated arthritis including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and inflammatory bowel disease
• Malignancy:
  • Bone metastasis from lung, breast, prostate, thyroid, among others
• Infectious:
  • Osteomyelitis
  • Abscess

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Pathophysiology

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Clinical features

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Diagnosis

Red flags:

Red flag	Possible cause
Previous history of cancer	Cancer
Unintentional weight loss
Loss of bladder/bowel control	Cauda equina syndrome
Significant motor/sensory loss
Loss of sensation in buttocks (saddle anaesthesia)
Significant trauma related to age	Fracture
Chronic corticosteroid use
Osteoporosis
Severe pain after lumbar surgery in past year	Infection
Fever
Urinary tract infection
Immunosuppression
Intravenous drug use

Imaging

CT scan:

MRI:

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Management

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Summary