Approach to Low Back Pain

Type

Term

Features

Classification

Acute

• Symptoms for < 4 weeks

Subacute

• Symptoms > 4 weeks to 12 weeks

Chronic

• Symptoms > 12 weeks

Terminology

Spondylosis

• Arthritis of the spine
• Radiographs usually show disc space narrowing and facet joint arthritis

Anterolisthesis

• Anterior displacement of vertebral body relative to the one below.

Spondylolisthesis 

• Anterolisthesis due to spondylolysis or any other cause

Retrolisthesis

• Posterior displacement of a vertebral body relative to the one below

Spondylolysis 

• Fracture in pars interarticularis at junction of vertebral body and posterior elements protecting the nerves
• Some patients have crack at L5 vertebrae

Spinal stenosis 

• Local, segmental, or generalized narrowing of vertebral canal by bone or soft tissue elements
• Usually due to bony hypertrophic changes in facet joints or thickened ligamentum flavum

Radiculopathy 

• Impairment of nerve root leading to radiating pain, numbness, tingling, or muscle weakness corresponding to a specific nerve root

Sciatica

• Pain, numbness, tingling in sciatic nerve distribution
• Radiation of symptoms down posterior or lateral leg, usually to the foot or ankle.

Cauda equina syndrome

• Loss of bowel and bladder control
• Numbness in groin and saddle area of perineum
• Associated with weakness of lower extremities