Back pain

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  • Trauma
  • Duration of pain
  • History of cancer
  • Weight loss
  • Night time pain
  • Cauda equina:
    • Saddle paresthesia/numbness
    • Weakness in legs
    • Urinary retention (early) / incontinence (later)
  • Sciatica symptoms

Physical

  • Inspection of back and posture
  • Range of motion
  • Palpation of the spine
  • Straight leg raising (for patients with leg symptoms)
  • Neurologic assessment of L5 and S1 roots (for patients with leg symptoms)
  • Evaluation for malignancy (breast, prostate, lymph node exam) when persistent pain or history strongly suggests systemic disease
  • Peripheral pulses

Imaging

Imaging is not necessary during the first 4 to 6 weeks, in the absence of any of the following criteria:

  • Progressive neurological findings
  • Constitutional symptoms
  • History of traumatic onset
  • History of malignancy
  • Age ≤ 18 years or ≥ 50 years
  • Infectious risk such as injection drug use, immunosuppression, indwelling urinary catheter, prolonged steroid use, skin or urinary tract infection
  • Osteoporosis