Last reviewed: 25 May 2021
Last updated: 10 Jun 2021



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
  • 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

Investigations to consider

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

Emerging tests

  • genetic testing
  • functional spinal imaging

Treatment algorithm


Consultant Spine Surgeon

Royal Orthopaedic Hospital




JSM declares that he has received research support from Stryker K2M, Medtronic, and CDMI; is a speaker for AO Spine and Scoliosis Research Society; serves on the editorial board for the European Spine Journal, the Spine Deformity Journal, and the Bone Joint Journal, and is a reviewer for the Global Spinal Journal.

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

Peer reviewersVIEW ALL

Consultant Spine Surgeon and Head of Department

Centre for Spinal Studies

Robert Jones and Agnes Hunt Hospital NHS Foundation Trust


Alder Hey University Children's Hospital




JT declares that he has no competing interests.

Associate Professor

Department of Neurosurgery

Stanford University




JR declares that he has no competing interests.

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