Low back pain differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Diagnosing the cause of back pain can be difficult, because many diseases can cause this symptom. Most frequently the cause is benign and/or self-limiting, but more serious causes may require urgent intervention. Acute back pain is a severe, persistent back pain of sudden onset that is likely to require surgical intervention to treat its cause. The following table summarizes differential diagnosis for back pain.

Differential Diagnosis of Back Pain

Classification of pain in the back based on etiology Diease Clinical Manifestation Diagnosis Comments
Symptoms Signs Lab findings Imaging
Vascular Aortic dissection
Aortic aneurysm

- Abdominal aneurysm

- Thoracic aneurysm

Neurological Spinal cord compression

- Thoracic spine

- Lumbar spine

Cauda equina compression
Radiculopathy
Epidural abscess
Bone Discitis
Vertebral osteomyelitis
Septic sacroilitis
Vertebral compression fracture
Spinal stenosis
Osteoarthritis
Ankylosing spondylitis
Chronic recurrent focal osteomyelitis
Scoliosis
Hyperkyphosis
Spondylosis

- Spondylolisthesis

Scheuermann (juvenile) kyphosis
Disc herniation
Sacroiliac joint dysfunction
Bertolotti's syndrome (Lumbosacral transitional vertebrae)
Non-spinal infections Pyomyositis
Pyelonephritis
Nephrolithiasis
Pelvic inflammatory disease
Pneumonia
Endocarditis
Myalgia
Cystitis
Cholelithiasis
Appendicitis
Inflammatory arthritis
Tumors Osteoid osteoma
Osteoblastoma
Ewing sarcoma
Osteosarcoma
Lymphoma
Prostate cancer
Neurofibroma
Leukemia
Langerhan cell histocytosis (eosinophilic granulomas)
Muscle-related Pyriformis syndrome
Miscellaneous Herpes zoster
Sickle cell anemia
Syringomyelia
Ureteropelvic junction obstruction
Chronic pain syndrome
Psychologic distress

References

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