TOC  | D-Dx        

lumbarspinalstenosis  

Low Back Pain Differential - Outlines in Clinical Medicine on Physicians' Online 2001

A. Anatomic

1. Muscular
2. Nerve compression (pain, paresthesias, sensory loss, weakness, incontinence)
3. Skeletal
   a.Degenerative Joint Disease
   b.Slipped Disk (esthesia)
   c.Fracture (vertebral): body, spinous / transverse process, pars interarticularis

B. Inflammatory

1. Osteomyelitis (blood cultures should be obtained especially in elderly patients)
2. Nonbony Infection: Soft Tissue Abscess, Pyelonephritis, Pyomyositis
3. Neoplastic Infiltration
4. Hyperplastic Bone Marrow - including sickle cell disease, myeloproliferative disease
5. Spondyloarthropathy, especially ankylosing spondylitis
6. Scleroderma

C. True Sciatica

1. Increased pain on straight leg raise, radiating down back of leg to foot (heal)
2. Sensory decrease or loss in dermatomal distribution
3. Herniated nucleus pulposus
4. Lateral or foraminal stenosis
5. Intraspinal mass - tumor or infection
6. Piriformis syndrome - buttock and leg pain, low back pain
7. Lumbar canal stenosis

D. Pseudosciatica

1. Osteoarthritis - hip disease
2. Trochanteric bursitis
3. Meralgia paresthetica
4. Diabetic amyotrophy
5. Vascular Claudication - pseudoclaudication
6. Malingering

Medical Conditions that can masquerade as back pain

REF: Cleveland C J of Medicine Dec. 2007. Vol 74:12

Emergent Conditions:

• Dissecting aortic aneurysm
• Ectopic pregnancy
• Myocardial infarction

Urgent Conditions:

• Acute pancreatitis
• Duodenal ulcers
• Pyelonephritis
• Visceral trauma

Potentially Serious Conditions:

• Nephrolithiasis
• Prostatitis
• Urinary tract infection
• Cholecystolithiasis
• Endometriosis
• Fibroids
• Pelvic inflammatory disease
• Pregnancy