Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • persistent low back pain
  • radicular leg pain
  • activity-related symptoms

Other diagnostic factors

  • restriction in lumbar motion
  • positive straight leg raise (SLR)
  • neurological deficit (leg weakness, sensory loss, bladder and bowel symptoms)

Risk factors

  • increasing age
  • genetic influence
  • occupation (excessive axial loads, vibrations from transportation)
  • tobacco smoking
  • facet joint tropism and arthritis
  • abnormal pelvic morphology
  • changes in sagittal alignment
  • obesity
  • diabetes mellitus
  • atherosclerosis

Diagnostic investigations

1st investigations to order

  • erect lumbar spine x-ray
  • MRI spine
Full details

Investigations to consider

  • CT spine
  • flexion/extension spine x-rays
  • single photon emission computed tomography (SPECT)
  • CT myelogram
  • discography
  • MRI with gadolinium (contrast)
Full details

Emerging tests

  • genetic testing
  • functional spinal imaging
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Spine Surgeon

Morriston Hospital

Swansea

ABMU Health Board

UK

Disclosures

JSM declares that he has no competing interests.

Dr Jwalant S. Mehta would like to gratefully acknowledge Dr Giannoulis Kyriakos and Dr Nasir Quiraishi, previous contributors to this monograph. GK and NQ declare that they have no competing interests.

Peer reviewers VIEW ALL

Consultant Spine Surgeon and Head of Department

Centre for Spinal Studies

Robert Jones and Agnes Hunt Hospital NHS Foundation Trust

Oswestry

Alder Hey University Children's Hospital

Liverpool

UK

Disclosures

JT declares that he has no competing interests.

Associate Professor

Department of Neurosurgery

Stanford University

Stanford

CA

Disclosures

JR declares that he has no competing interests.

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