Differential diagnosis of low back pain

Mechanical low back pain	Nonmechanical spine disease	Visceral disease
Lumbar strain Degenerative disease Discs (spondylosis) Facet joints (osteoarthritis) Spondylolisthesis Herniated disc Spinal stenosis Osteoporosis Fractures Congenital disease Severe kyphosis Severe scoliosis Possible type II or type IV transitional vertebra^* Possible spondylolysis Possible facet joint asymmetry	Neoplasia Multiple myeloma Metastatic carcinoma Lymphoma and leukemia Spinal cord tumors Retroperitoneal tumors Infection Osteomyelitis Septic discitis Paraspinous abscess Epidural abscess Inflammatory arthritis (often HLA-B27-associated) Ankylosing spondylitis Psoriatic spondylitis Reactive arthritis Inflammatory bowel disease Scheuermann disease (osteochondrosis) Paget disease	Pelvic organs Prostatitis Endometriosis Chronic pelvic inflammatory disease Kidney disease Nephrolithiasis Pyelonephritis Perinephric abscess Aortic aneurysm Gastrointestinal disease Pancreatitis Cholecystitis Penetrating ulcer Fat herniation of lumbar space

HLA: human leukocyte antigen.

* A transitional vertebra is a congenital anomaly in which there is a naturally occurring articulation or bony fusion between the transverse processes of L5 and the sacrum, but there is still a small remnant disc space between L5 and the sacrum. Type II means that 1 or both transverse processes appear to form a diarthrodial joint with the sacrum, but there is no bony fusion. Type IV means that there is a type II abnormality on 1 side and a complete bony fusion on the opposite side.

Graphic 60679 Version 12.0

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Differential diagnosis of low back pain

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