Assessment of back pain


Key articles

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

American College of Radiology. ACR appropriateness criteria: suspected spine trauma. 2018 [internet publication].Full text  Abstract

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

Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct 2;147(7):478-91.Full text  Abstract

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

Reference articles

1. Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020 Mar;8(6):299.Full text  Abstract

2. Balagué F, Mannion AF, Pellisé F, et al. Non-specific low back pain. Lancet. 2012 Feb 4;379(9814):482-91. Abstract

3. Edwards J, Hayden J, Asbridge M, et al. Prevalence of low back pain in emergency settings: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2017 Apr 4;18(1):143.Full text  Abstract

4. Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018 Nov;27(11):2791-2803.Full text  Abstract

5. Henschke N, Maher CG, Refshauge KM, et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ. 2008 Jul 7;337:a171.Full text  Abstract

6. Williams CM, Maher CG, Latimer J, et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet. 2014 Nov 1;384(9954):1586-96.Full text  Abstract

7. Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-530.Full text  Abstract

8. Chou R, Shekelle P. Will this patient develop persistent disabling low back pain? JAMA. 2010 Apr 7;303(13):1295-302. Abstract

9. Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001 Feb 1;344(5):363-70. Abstract

10. Frymoyer JW. Back pain and sciatica. N Engl J Med. 1988 Feb 4;318(5):291-300. Abstract

11. Will JS, Bury DC, Miller JA. Mechanical low back pain. Am Fam Physician. 2018 Oct 1;98(7):421-428.Full text  Abstract

12. Yang G, Liao W, Shen M, et al. Insight into neural mechanisms underlying discogenic back pain. J Int Med Res. 2018 Nov;46(11):4427-4436.Full text  Abstract

13. Ghormley RK. Low back pain. With special reference to the articular facets, with presentation of an operative procedure. JAMA. 1933;101(23):1773-77.

14. Giles LG, Harvey AR. Immunohistochemical demonstration of nociceptors in the capsule and synovial folds of human zygapophyseal joints. Br J Rheumatol. 1987 Oct;26(5):362-4. Abstract

15. Mclain RF. Mechanoreceptor endings in human cervical facet joints. Spine. 1994 Mar 1;19(5):495-501. Abstract

16. Bozzao A, Gallucci M, Masciocchi C, et al. Lumbar disc herniation: MR imaging assessment of natural history in patients treated without surgery. Radiology. 1992 Oct;185(1):135-41. Abstract

17. Delauche-Cavallier MC, Budet C, Laredo J-D, et al. Lumbar disc herniation: computed tomography scan changes after conservative treatment of nerve root compression. Spine. 1992 Aug;17(8):927-33. Abstract

18. Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 2016 Jan 4;352:h6234.Full text  Abstract

19. Roche MB, Rowe GG. The incidence of separate neural arch and coincident bone variations. A survey of 4,200 skeletons. Anat Rec. 1951 Feb;109(2):233-52. Abstract

20. Amato M, Totty WG, Gilula LA. Spondylolysis of the lumbar spine: demonstration of defects and laminal fragmentation. Radiology. 1984 Dec;153(3):627-9. Abstract

21. Fredrickson BE, Baker D, McHolick WJ, et al. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am. 1984 Jun;66(5):699-707. Abstract

22. McCarthy J, Davis A. Diagnosis and management of vertebral compression fractures. Am Fam Physician. 2016 Jul 1;94(1):44-50.Full text  Abstract

23. Simopoulos TT, Manchikanti L, Singh V, et al. A systematic evaluation of prevalence and diagnostic accuracy of sacroiliac joint interventions. Pain Physician. 2012 May-Jun;15(3):E305-44.Full text  Abstract

24. Simopoulos TT, Manchikanti L, Gupta S, et al. Systematic review of the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions. Pain Physician. 2015 Sep-Oct;18(5):E713-56.Full text  Abstract

25. Altaf F, Gibson A, Dannawi Z, et al. Adolescent idiopathic scoliosis. BMJ. 2013 Apr 30;346:f2508.Full text  Abstract

26. Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997 Mar;79(3):364-8.Full text  Abstract

27. Alerhand S, Wood S, Long B, et al. The time-sensitive challenge of diagnosing spinal epidural abscess in the emergency department. Intern Emerg Med. 2017 Dec;12(8):1179-83. Abstract

28. National Institute for Health and Care Excellence. Spondyloarthritis in over 16s: diagnosis and management. Jun 2017 [internet publication].Full text

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

30. Ramírez N, Olivella G, Valentín P, et al. Are constant pain, night pain, or abnormal neurological examination adequate predictors of the presence of a significant pathology associated with pediatric back pain? J Pediatr Orthop. 2019 Jul;39(6):e478-e481.Full text  Abstract

31. American College of Radiology. ACR appropriateness criteria: suspected spine trauma. 2018 [internet publication].Full text  Abstract

32. American College of Radiology. ACR appropriateness criteria: suspected retroperitoneal bleed. 2021 [internet publication].Full text  Abstract

33. Henschke N, Maher CG, Refshauge KM. A systematic review identifies five "red flags" to screen for vertebral fracture in patients with low back pain. J Clin Epidemiol. 2008 Feb;61(2):110-18. Abstract

34. Downie A, Williams CM, Henschke N, et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ. 2013 Dec 11;347:f7095.Full text  Abstract

35. Rossiter DJ, Haider Z, David B, et al. How not to miss major spinal pathology in patients with back pain. Br J Hosp Med (Lond). 2017 May 2;78(5):C66-9. Abstract

36. Parreira PCS, Maher CG, Traeger AC, et al. Evaluation of guideline-endorsed red flags to screen for fracture in patients presenting with low back pain. Br J Sports Med. 2019 May;53(10):648-654.Full text  Abstract

37. American College of Radiology. ACR appropriateness criteria: suspected spine infection. 2021 [internet publication].Full text  Abstract

38. Bailitz J, Starr F, Beecroft M, et al. CT should replace three-view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma. 2009 Jun;66(6):1605-9.Full text  Abstract

39. Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. 2000 Dec;23(4):175-204. Abstract

40. Diehn FE. Imaging of spine infection. Radiol Clin North Am. 2012 Jul;50(4):777-98.Full text  Abstract

41. Johnson CD, Besselink MG, Carter R. Acute pancreatitis. BMJ. 2014 Aug 12;349:g4859. Abstract

42. Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013 Sep;108(9):1400-15; 1416.Full text  Abstract

43. Rompianesi G, Hann A, Komolafe O, et al. Serum amylase and lipase and urinary trypsinogen and amylase for diagnosis of acute pancreatitis. Cochrane Database Syst Rev. 2017 Apr 21;(4):CD012010.Full text  Abstract

44. van Dijk SM, Hallensleben NDL, van Santvoort HC, et al. Acute pancreatitis: recent advances through randomised trials. Gut. 2017 Nov;66(11):2024-32. Abstract

45. Basurto Ona X, Rigau Comas D, Urrútia G. Opioids for acute pancreatitis pain. Cochrane Database Syst Rev. 2013 Jul 26;(7):CD009179.Full text  Abstract

46. Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018 Jan;67(1):2-77.e2.Full text  Abstract

47. Roberts K, Revell M, Youssef H, et al. Hypotensive resuscitation in patients with ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 2006 Apr;31(4):339-44.Full text  Abstract

48. Ropper AH, Zafonte RD. Sciatica. N Engl J Med. 2015 Mar 26;372(13):1240-8.Full text  Abstract

49. Jensen RK, Kongsted A, Kjaer P, et al. Diagnosis and treatment of sciatica. BMJ. 2019 Nov 19;367:l6273.Full text  Abstract

50. Parreira P, Maher CG, Steffens D, et al. Risk factors for low back pain and sciatica: an umbrella review. Spine J. 2018 Sep;18(9):1715-21. Abstract

51. Mylona E, Samarkos M, Kakalou E, et al. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum. 2009 Aug;39(1):10-7.Full text  Abstract

52. Ursprung WM, Kettner NW, Boesch R. Vertebral osteomyelitis: a case report of a patient presenting with acute low back pain. J Manipulative Physiol Ther. 2005 Nov-Dec;28(9):713-8. Abstract

53. Eren Gök S, Kaptanoğlu E, Celikbaş A, et al. Vertebral osteomyelitis: clinical features and diagnosis. Clin Microbiol Infect. 2014 Oct;20(10):1055-60.Full text  Abstract

54. Maccauro G, Spinelli MS, Mauro S, et al. Physiopathology of spine metastasis. Int J Surg Oncol. 2011 Aug 10 [Epub ahead of print].Full text  Abstract

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

56. Grødahl LH, Fawcett L, Nazareth M, et al. Diagnostic utility of patient history and physical examination data to detect spondylolysis and spondylolisthesis in athletes with low back pain: a systematic review. Man Ther. 2016 Aug;24:7-17. Abstract

57. Alqarni AM, Schneiders AG, Hendrick PA. Clinical tests to diagnose lumbar segmental instability: a systematic review. J Orthop Sports Phys Ther. 2011 Mar;41(3):130-40.Full text  Abstract

58. Troke M, Moore AP, Maillardet FJ, et al. A new, comprehensive normative database of lumbar spine ranges of motion. Clin Rehabil. 2001 Aug;15(4):371-9.Full text  Abstract

59. Bible JE, Biswas D, Miller CP, et al. Normal functional range of motion of the lumbar spine during 15 activities of daily living. J Spinal Disord Tech. 2010 Apr;23(2):106-12.Full text  Abstract

60. Prather H, Cheng A, Steger-May K, et al. Hip and lumbar spine physical examination findings in people presenting with low back pain, with or without lower extremity pain. J Orthop Sports Phys Ther. 2017 Mar;47(3):163-172.Full text  Abstract

61. Soucie JM, Wang C, Forsyth A, et al. Range of motion measurements: reference values and a database for comparison studies. Haemophilia. 2011 May;17(3):500-7.Full text  Abstract

62. Deville WL, van der Windt DA, Dzaferagic A, et al. The test of Lasegue: systematic review of the accuracy in diagnosing herniated discs. Spine. 2000 May 1;25(9):1140-7. Abstract

63. Rubinstein SM, van Tulder M. A best-evidence review of diagnostic procedures for neck and low-back pain. Best Pract Res Clin Rheumatol. 2008 Jun;22(3):471-82. Abstract

64. van der Windt DA, Simons E, Riphagen II, et al. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev. 2010 Feb 17;(2):CD007431.Full text  Abstract

65. Al Nezari NH, Schneiders AG, Hendrick PA. Neurological examination of the peripheral nervous system to diagnose lumbar spinal disc herniation with suspected radiculopathy: a systematic review and meta-analysis. Spine J. 2013 Jun;13(6):657-74. Abstract

66. Estridge MN, Rouhe SA, Johnson NG. The femoral stretching test. A valuable sign in diagnosing upper lumbar disc herniations. J Neurosurg. 1982 Dec;57(6):813-7. Abstract

67. van der Wurff P, Buijs EJ, Groen GJ. A multitest regimen of pain provocation tests as an aid to reduce unnecessary minimally invasive sacroiliac joint procedures. Arch Phys Med Rehabil. 2006 Jan;87(1):10-4.Full text  Abstract

68. Laslett M, Aprill CN, McDonald B, et al. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Man Ther. 2005 Aug;10(3):207-18.Full text  Abstract

69. Kokmeyer DJ, Van der Wurff P, Aufdemkampe G, et al. The reliability of multitest regimens with sacroiliac pain provocation tests. J Manipulative Physiol Ther. 2002 Jan;25(1):42-8.Full text  Abstract

70. Masci L, Pike J, Malara F, et al. Use of the one‐legged hyperextension test and magnetic resonance imaging in the diagnosis of active spondylolysis. Br J Sports Med. 2006 Nov;40(11):940-6. Abstract

71. Chou R, Fu R, Carrino JA, et al. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009 Feb 7;373(9662):463-72. Abstract

72. Chou R, Qaseem A, Owens DK, et al. Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Ann Intern Med. 2011 Feb 1;154(3):181-9. Abstract

73. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct 2;147(7):478-91.Full text  Abstract

74. Weishaupt D, Zanetti M, Hodler J, et al. MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology. 1998 Dec;209(3):661-6. Abstract

75. Stadnik TW, Lee RR, Coen HL, et al. Annular tears and disk herniation: prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica. Radiology. 1998 Jan;206(1):49-55. Abstract

76. Tonosu J, Oka H, Higashikawa A, et al. The associations between magnetic resonance imaging findings and low back pain: a 10-year longitudinal analysis. PLoS One. 2017 Nov 15;12(11):e0188057.Full text  Abstract

77. Boden SD, Davis DO, Dina TS, et al. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990 Mar;72(3):403-8. Abstract

78. Burgstaller JM, Schüffler PJ, Buhmann JM, et al. Is there an association between pain and magnetic resonance imaging parameters in patients with lumbar spinal stenosis? Spine (Phila Pa 1976). 2016 Sep;41(17):E1053-62. Abstract

79. Clark EM, Cummings SR, Schousboe JT. Spinal radiographs in those with back pain-when are they appropriate to diagnose vertebral fractures? Osteoporos Int. 2017 Aug;28(8):2293-7. Abstract

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

81. Hansen BB, Nordberg CL, Hansen P, et al. Weight-bearing MRI of the lumbar spine: spinal stenosis and spondylolisthesis. Semin Musculoskelet Radiol. 2019 Dec;23(6):621-33.Full text  Abstract

82. Jackson DW, Wiltse LL, Cirincoine RJ. Spondylolysis in the female gymnast. Clin Orthop. 1976 Jun;(117):68-73. Abstract

83. Moritani T, Kim J, Capizzano AA, et al. Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections. Br J Radiol. 2014 Sep;87(1041):20140011.Full text  Abstract

84. Stäbler A, Reiser MF. Imaging of spinal infection. Radiol Clin North Am. 2001 Jan;39(1):115-35. Abstract

85. Kobayashi N, Bauer TW, Togawa D, et al. A molecular gram stain using broad range PCR and pyrosequencing technology: a potentially useful tool for diagnosing orthopaedic infections. Diagn Mol Pathol. 2005 Jun;14(2):83-9. Abstract

86. Kobayashi N, Bauer TW, Sakai H, et al. The use of newly developed real-time PCR for the rapid identification of bacteria in culture-negative osteomyelitis. Joint Bone Spine. 2006 Dec;73(6):745-7. Abstract

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