UpToDate خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده:
4
September 2025
| Etiology | Comorbidities | Key features on history or physical examination | Initial imaging | Additional initial studies |
| Urgent and acute conditions | ||||
| Spinal cord compression or cauda equina syndrome | Patients with malignancy-associated cord compression may have a personal history of cancer | Progressive moderate or severe weakness, falls or gait instability, urinary retention, overflow incontinence, fecal incontinence, saddle anesthesia, or other sensory changes | MRI without contrast; MRI with and without contrast is indicated if there is suspicion for malignancy or infection, or a history of prior surgery at the site | None |
| Metastatic cancer | History of smoking; family or personal history of cancer | Constitutional symptoms including unintentional weight loss, fever, and night sweats Pain is typically sudden and severe in onset May have neurologic symptoms if concomitant spinal cord compression is present | MRI with and without contrast if acute or neurologic symptoms are present Lumbosacral radiography is an appropriate initial study if onset of pain is >4 weeks' duration and no neurologic symptoms are present | ESR, CRP |
| Epidural abscess or vertebral osteomyelitis | Recent bacteremia or contiguous bony/soft tissue infection, history of injection drug use or spinal procedure | The clinical presentation may vary from mild discomfort to overt neurologic symptoms depending on the extent of the infection Fever, chills, and malaise are suggestive of infection, though these are not always present | MRI with and without contrast | ESR, CRP, blood cultures; WBC may be elevated or normal |
| Vertebral compression fracture | Osteoporosis, chronic glucocorticoid exposure, preceding trauma | Advanced age Pain may be slowly progressive May have neurologic symptoms if progresses to nerve involvement | Lumbosacral radiography | None |
| History of cancer is associated with pathologic fracture | Pain is typically sudden and severe | MRI with and without contrast Lumbosacral radiography is an appropriate initial study if onset of pain is subacute (>4 weeks) | ||
| Radiculopathy | Burning radicular pain, sensory loss, weakness, and reflex changes, most commonly in the L4, L5, or S1 nerve root distribution* | Consider imaging if >1 nerve root involved, progressive symptoms, or risk of metastatic cancer or infection | None | |
| Subacute and chronic conditions | ||||
| Spinal stenosis | Spondylosis, spondylolistheses, thickening of the ligamentum flavum, osteoarthritis | Older age, pseudoclaudication (ambulation-induced pain to the lower extremity, resolving with sitting), radicular leg pain | No imaging indicated on initial presentation Consider MRI if progressive symptoms or symptoms present >4 weeks | None |
| Axial spondyloarthritis | Associated extraarticular features include uveitis, inflammatory bowel disease, and psoriasis | Younger age, back pain with inflammatory features (morning stiffness, improvement with exercise) | Anteroposterior pelvis radiographs | ESR, CRP, HLA-B27 |
| Osteoarthritis | Older age Pain exacerbated by activity and relieved by rest Chronic osteoarthritis may lead to spinal stenosis in some cases | No imaging indicated on initial presentation | None | |
| Scoliosis and kyphosis | Congenital vertebral anomaly, osteoporosis, or degenerative disc disease | Thoracic or lumbar asymmetry of the spinal curvature | Anteroposterior and lateral spine radiographs | None |
CRP: c-reactive protein; ESR: erythrocyte sedimentation rate; HLA-B27: human leukocyte antigen B27; MRI: magnetic resonance imaging; WBC: white blood cell.
* Refer to related UpToDate content for further details regarding solitary nerve root lesions of the lumbar spine.
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