Resumo
Definição
History and exam
Key diagnostic factors
- obesidad, estrés y comorbilidades psiquiátricas
- antecedentes de dolor lumbar
- la radiación del dolor no se extiende más allá de la rodilla
- ausencia de síntomas de alarma
- ausencia de fiebre, fluctuación, sensibilidad agudísima a la palpación
- exámenes sensoriales, motores y de reflejos osteotendinosos profundos dentro de los límites normales
- prueba negativa de elevación de pierna recta o cruzada recta
Other diagnostic factors
- dolor sordo, mordiente, desgarrador, de ardor o eléctrico asociado a espasmos musculares
- ausencia de dolor con la flexión o alivio con la extensión
- escoliosis o cifosis
- pruebas FABER, de Gaenslen o de Schober negativas
Risk factors
- obesidad
- antecedentes familiares de discopatía degenerativa
- poca flexibilidad musculotendinosa y postura anormal
- estrés y comorbilidades psiquiátricas
- mayor edad
- sexo femenino
- actividades físicas y laborales intensas
- consumo de tabaco
- permanecer de pie por períodos prolongados
- niveles de la vitamina D
Diagnostic investigations
1st investigations to order
- diagnóstico clínico
Investigations to consider
- resonancia magnética (IRM) de la columna lumbar
- radiografía de la columna lumbar
- tomografía computarizada (TC) de la columna lumbar
- mielografía
- hemograma completo (HC)
- velocidad de sedimentación globular (VSG)
- proteína C reactiva (PCR)
- cultivo y análisis de orina
- hemocultivos
- gammagrafía ósea con radionucleidos
- electromiograma (EMG)
Treatment algorithm
dolor lumbar agudo y subagudo (≤12 semanas)
dolor crónico en la zona lumbar (>12 semanas)
lumbalgia recurrente
Contributors
Authors
Andrew Sherman, MD, MS
Professor and Vice Chair
Department of Physical Medicine & Rehabilitation
University of Miami Miller School of Medicine
Miami
FL
Disclosures
AS declares that he has no competing interests.
Acknowledgements
Dr Andrew Sherman would like to gratefully acknowledge Dr Robert W. Irwin, Dr Louise Thwaites, Dr Karen Walker-Bone, Dr Joanne Borg-Stein, and Dr Philip Chiou, previous contributors to this topic.
Disclosures
RWI, LT, KWB, JBS, and PC declare that they have no competing interests.
Peer reviewers
Jennifer Baima, MD
Staff Physiatrist
Orthopedic and Arthritis Center
Brigham and Women's Hospital
Chestnut Hill
MA
Disclosures
JB declares that she has no competing interests.
Alexios G. Carayannopoulos, DO, MPH
Interventional Spine Physiatrist
Pain Medicine Specialist
Medical Director
Spine Center
Lahey Clinic
Burlington
MA
Disclosures
AGC declares that he has no competing interests.
References
Key articles
American College of Radiology. ACR appropriateness criteria: low back pain. 2021 [internet publication].Full text
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):514-30.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
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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