Evaluation of back pain

Last reviewed: 2 Apr 2025
Last updated: 12 Dec 2024

Summary

Differentials

Common

  • Lumbar muscular strain/sprain
  • Herniated nucleus pulposus
  • Spinal stenosis
  • Compression fracture
  • Degenerative disk disease or facet arthropathy
  • Sacroiliitis
Full details

Uncommon

  • Cauda equina syndrome
  • Spinal cord compression
  • Spondylolysis and/or spondylolisthesis
  • Vertebral discitis/osteomyelitis
  • Malignancy
  • Inflammatory spondyloarthropathy
  • Connective tissue disease
  • Scoliosis
  • Abdominal aortic aneurysm
  • Acute pancreatitis
  • Pyelonephritis
  • Renal colic
  • Peptic ulcer disease
  • Spinal epidural abscess
  • Herpes zoster infection
  • Retroperitoneal bleed
Full details

Contributors

Authors

Daniel K. Park, MD
Daniel K. Park

Associate Professor

Department of Orthopedic Surgery

William Beaumont Hospital

Royal Oak

MI

Disclosures

DKP is a paid consultant for Stryker, Arthrex, Medynus, Kuros, and Amplify; and holds stock in Stryker, Surgalign, and Johnson and Johnson. He is a paid editor for AAOS Orthoinfo.

Kern Singh, MD
Kern Singh

Professor

Department of Orthopedic Surgery

Rush University Medical Center

Chicago

IL

Disclosures

KS has received royalties from Zimmer, Stryker, RTI Surgical, Lippincott Williams & Wilkins, Thieme, Jaypee Publishing, and Slack Publishing. He holds stock in Avaz Surgical LLC, and Vital 5 LLC, has consulted for Depuy, Zimmer, K2M, and Stryker, is a board member of Vital 5 LLC, TDi LLC, Minimally Invasive Spine Study Group, is on the board of directors for CSRS, ISASS, AAOS, and is on the editorial board for Contemporary Spine Surgery and Orthopedics Today. KS has received a CSRS resident grant.

Acknowledgements

Dr Daniel K. Park and Dr Kern Singh would like to gratefully acknowledge Dr Howard S. An, a previous contributor to this topic.

Disclosures

HSA declares that he has no competing interests.

Peer reviewers

Eric L. Matteson, MD

Professor of Medicine

Mayo Clinic College of Medicine

Division of Rheumatology

Rochester

MN

Disclosures

ELM declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. Dec 2020 [internet publication].Full text

American College of Radiology. ACR appropriateness criteria: low back pain. 2021 [internet publication].Full text  Abstract

American College of Radiology. ACR appropriateness criteria: acute spinal trauma. 2024 [internet publication].Full text

American College of Radiology. ACR appropriateness criteria: inflammatory back pain: known or suspected axial spondyloarthritis. 2021 [internet publication].Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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