Specific spinal pathologies in adult patients with an acute or subacute atraumatic low back pain in the emergency department
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The primary aim in the evaluation of patients presenting with acute or subacute low back pain (LBP) is to exclude a possible specific spinal pathology. Literature on the population-based incidences of these pathologies is scarce. The aim of our study was to investigate the population-based incidence of specific spinal pathologies as a cause of atraumatic acute or subacute LBP.
From our institutional database, we identified all patients with a relevant LBP-related ICD-10 code during a visit to our emergency department (ED) in a level II/III teaching hospital between January 2012 and December 2014. Patients with a possible specific spinal pathology (cauda equina syndrome, spondylodiscitis, vertebral fracture, and cancer) were assessed in detail.
A total of 900 visits were due to atraumatic low back pain. Of these 284 (31.6%) were due to nonspecific LBP, and 583 (64.8%) due to radicular pain suggesting nerve root compression. In 33 (3.7%) cases, the LBP was caused by a specific spinal pathology. The annual incidences per 100,000 were 0.60 for CES, 2.1 for spondylodiscitis, 0.76 for cancer and 1.2 for compression fracture.
The incidences of specific spinal pathologies were low. Given that LBP is a very common symptom, it is not surprising that the accuracy of red flag symptoms is poor. Each patient should be considered individually, and we advocate a low threshold for referral and advanced imaging in cases where a specific spinal pathology is suspected.
KeywordsLow back pain Red flag Incidence Specific pathology Diagnostic triage
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, Koes B, Laerum E, Malmivaara A, COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care (2006) Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 15(Suppl 2):S169–S191. https://doi.org/10.1007/s00586-006-1071-2 CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Chou R, Qaseem A, Snow V, Casey D, Cross JT, Jr SP, Owens DK, Clinical Efficacy Assessment Subcommittee of the American College of Physicians, American College of Physicians, American Pain Society Low Back Pain Guidelines Panel (2007) Diagnosis and treatment of low back pain: a joint clinical practice guideline from the american college of physicians and the american pain society. Ann Intern Med 147:478–491CrossRefPubMedGoogle Scholar
- 5.Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, York J, Das A, McAuley JH (2009) Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum 60:3072–3080. https://doi.org/10.1002/art.24853 CrossRefPubMedGoogle Scholar
- 14.Melton LJ 3rd, Wenger DE, Atkinson EJ, Achenbach SJ, Berquist TH, Riggs BL, Jiang G, Eastell R (2006) Influence of baseline deformity definition on subsequent vertebral fracture risk in postmenopausal women. Osteoporos Int 17:978–985. https://doi.org/10.1007/s00198-006-0106-1 CrossRefPubMedGoogle Scholar
- 17.Sorensen J, Hetland ML, all departments of rheumatology in Denmark (2015) Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis: results from the danish nationwide DANBIO registry. Ann Rheum Dis 74:e12-2013-204867. https://doi.org/10.1136/annrheumdis-2013-204867 CrossRefGoogle Scholar