Overview of Lumbar Spine Assessment: Difference between revisions

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== Introduction ==
== Introduction ==
Low back pain is the leading cause of disability in most countries,<ref>GBD 2021 Low Back Pain Collaborators. [https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00098-X/fulltext Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021]. Lancet Rheumatol. 2023 May 22;5(6):e316-e329.</ref> with a point prevalence of 11.9%.<ref>Bastos RM, Moya CR, de Vasconcelos RA, Costa LO. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9344960/ Treatment-based classification for low back pain: systematic review with meta-analysis.] Journal of Manual & Manipulative Therapy. 2022 Jul 4;30(4):207-27.</ref> Years lived with disability caused by low back pain are continuing to increase, and the socioeconomic burden of low back pain is high.<ref>Dutmer AL, Schiphorst Preuper HR, Soer R, Brouwer S, Bültmann U, Dijkstra PU, et al. [https://journals.lww.com/spinejournal/Fulltext/2019/12150/Personal_and_Societal_Impact_of_Low_Back_Pain__The.9.aspx Personal and societal impact of low back pain: the Groningen Spine Cohort]. Spine (Phila Pa 1976). 2019 Dec 15;44(24):E1443-E1451. </ref> Around half of all individuals with low back pain seek care,<ref>Almeida M, Saragiotto B, Richards B, Maher CG. [https://onlinelibrary.wiley.com/doi/full/10.5694/mja17.01152 Primary care management of non-specific low back pain: key messages from recent clinical guidelines]. Med J Aust. 2018 Apr 2;208(6):272-5.</ref> and it is estimated that around 60 percent of patients presenting to a primary care physician have a complaint of low back pain.<ref>Gibbs D, McGahan BG, Ropper AE, Xu DS. [https://www.sciencedirect.com/science/article/abs/pii/S0733861922000585?via%3Dihub Back pain: differential diagnosis and management]. Neurol Clin. 2023 Feb;41(1):61-76.</ref> It is, therefore, important that rehabilitation providers have a comprehensive understanding of the lumbar spine evaluation. This page provides an overview of this evaluation and includes links for more information.
Low back pain is the leading cause of disability in most countries,<ref>GBD 2021 Low Back Pain Collaborators. [https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00098-X/fulltext Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021]. Lancet Rheumatol. 2023 May 22;5(6):e316-e329.</ref> with a point prevalence of 11.9%.<ref>Bastos RM, Moya CR, de Vasconcelos RA, Costa LO. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9344960/ Treatment-based classification for low back pain: systematic review with meta-analysis.] Journal of Manual & Manipulative Therapy. 2022 Jul 4;30(4):207-27.</ref> Years lived with disability caused by low back pain are continuing to increase, and the socioeconomic burden of low back pain is high.<ref>Dutmer AL, Schiphorst Preuper HR, Soer R, Brouwer S, Bültmann U, Dijkstra PU, et al. [https://journals.lww.com/spinejournal/Fulltext/2019/12150/Personal_and_Societal_Impact_of_Low_Back_Pain__The.9.aspx Personal and societal impact of low back pain: the Groningen Spine Cohort]. Spine (Phila Pa 1976). 2019 Dec 15;44(24):E1443-E1451. </ref> Around half of all individuals with low back pain seek care,<ref>Almeida M, Saragiotto B, Richards B, Maher CG. [https://onlinelibrary.wiley.com/doi/full/10.5694/mja17.01152 Primary care management of non-specific low back pain: key messages from recent clinical guidelines]. Med J Aust. 2018 Apr 2;208(6):272-5.</ref> and it is estimated that around 60 percent of patients presenting to a primary care physician have a complaint of low back pain.<ref>Gibbs D, McGahan BG, Ropper AE, Xu DS. [https://www.sciencedirect.com/science/article/abs/pii/S0733861922000585?via%3Dihub Back pain: differential diagnosis and management]. Neurol Clin. 2023 Feb;41(1):61-76.</ref> It is, therefore, important that rehabilitation providers have a comprehensive understanding of the lumbar spine evaluation. This page provides an overview of this evaluation and includes links for more information.
== History ==
When assessing patients with low back pain, age can help us formulate hypothetical diagnoses about the potential pathoanatomical cause of pain:<ref>Cunningham S. Lumbar Spine Evaluation Course. Plus, 2024.</ref>
* individuals aged less than 20 years old: low back pain is rare (apart from muscle sprains), so check for anomalies (e.g. spondylolisthesis)
* individuals aged between 20 and 50 years: more likely a disc pathology, muscle strain or instability
* individuals aged more than 50 years: more likely associated with degeneration, so consider conditions such as arthritis or spondylosis
<blockquote>The mnemonic L-M-N-O-P-Q-R-S-T is used to cover the key aspects you should consider when taking a patient’s history.</blockquote>
== References ==

Revision as of 09:57, 20 December 2023

Original Editor - Shala Cunningham Top Contributors - Jess Bell and Stacy Schiurring
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Introduction[edit | edit source]

Low back pain is the leading cause of disability in most countries,[1] with a point prevalence of 11.9%.[2] Years lived with disability caused by low back pain are continuing to increase, and the socioeconomic burden of low back pain is high.[3] Around half of all individuals with low back pain seek care,[4] and it is estimated that around 60 percent of patients presenting to a primary care physician have a complaint of low back pain.[5] It is, therefore, important that rehabilitation providers have a comprehensive understanding of the lumbar spine evaluation. This page provides an overview of this evaluation and includes links for more information.

History[edit | edit source]

When assessing patients with low back pain, age can help us formulate hypothetical diagnoses about the potential pathoanatomical cause of pain:[6]

  • individuals aged less than 20 years old: low back pain is rare (apart from muscle sprains), so check for anomalies (e.g. spondylolisthesis)
  • individuals aged between 20 and 50 years: more likely a disc pathology, muscle strain or instability
  • individuals aged more than 50 years: more likely associated with degeneration, so consider conditions such as arthritis or spondylosis

The mnemonic L-M-N-O-P-Q-R-S-T is used to cover the key aspects you should consider when taking a patient’s history.

References[edit | edit source]

  1. ↑ GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023 May 22;5(6):e316-e329.
  2. ↑ Bastos RM, Moya CR, de Vasconcelos RA, Costa LO. Treatment-based classification for low back pain: systematic review with meta-analysis. Journal of Manual & Manipulative Therapy. 2022 Jul 4;30(4):207-27.
  3. ↑ Dutmer AL, Schiphorst Preuper HR, Soer R, Brouwer S, Bültmann U, Dijkstra PU, et al. Personal and societal impact of low back pain: the Groningen Spine Cohort. Spine (Phila Pa 1976). 2019 Dec 15;44(24):E1443-E1451.
  4. ↑ Almeida M, Saragiotto B, Richards B, Maher CG. Primary care management of non-specific low back pain: key messages from recent clinical guidelines. Med J Aust. 2018 Apr 2;208(6):272-5.
  5. ↑ Gibbs D, McGahan BG, Ropper AE, Xu DS. Back pain: differential diagnosis and management. Neurol Clin. 2023 Feb;41(1):61-76.
  6. ↑ Cunningham S. Lumbar Spine Evaluation Course. Plus, 2024.
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