Low Back Pain Causes

Aka: Low Back Pain Causes, Differential Diagnosis of Low Back Pain

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II. Causes: Mechanical (90%)

  1. Lumbosacral strain (70-90% of Acute Low Back Pain)
    1. Isolated Trauma or repetitive overuse
  2. Lumbar Spondylosis (10%)
    1. Chronic disc degeneration and secondary foraminal narrowing in over age 40 years old
  3. Lumbar Disc Herniation (5%)
    1. Occurs at L4-5 or L5-S1 in 90-95% of cases
  4. Spondylolysis (<5%)
    1. Young athletes with frequent lumbar hyperextension (e.g. gymnastics, football)
  5. Vertebral Compression Fracture (4%)
    1. Vertebral Fracture and collapse, typically due to Osteoporosis, and most commonly at L1 and L4
  6. Spondylolisthesis (3-4%)
    1. Vertebral slippage anteriorly, at L5 in 90% of cases, with Leg Pain, Paresthesias and weakness
  7. Lumbar Spinal Stenosis (3%)
    1. Narrowing of lumbar spinal canal with back pain and leg numbness, weakness better with rest
    2. Includes Cauda Equina Syndrome (requiring emergent intervention)
  8. Spondylosis
    1. Chronic disk degeneration
    2. Facet joint Arthropathy
  9. Sacroiliac Joint
    1. Sacroiliac Joint Dysfunction
    2. Spondyloarthropathy

III. Causes: Non-Mechanical

  1. See Low Back Pain Red Flags
  2. Spondyloarthropathy
    1. Ankylosing Spondylitis
    2. Reiter's Syndrome
  3. Spinal Infection
    1. Vertebral Diskitis
    2. Spinal Osteomyelitis
    3. Spinal Epidural Abscess
  4. Osteoporosis (Vertebral Compression Fracture)
  5. Cauda Equina Syndrome
  6. Spinal Neoplasm (Spine Metastases, Vertebral Metastases)
  7. Connective Tissue Disease
  8. Referred visceral pain
    1. Abdominal Aortic Aneurysm
    2. Pancreatic Cancer
    3. Genitourinary cancer

IV. Causes: Referred Pain

  1. Vascular
    1. Abdominal Aortic Aneurysm
  2. Gastrointestinal
    1. Pancreatitis
    2. Peptic Ulcer Disease
    3. Cholecystitis
  3. Renal
    1. Nephrolithiasis
    2. Pyelonephritis
  4. Genitourinary
    1. Endometriosis
    2. Pelvic Inflammatory Disease
    3. Prostatitis
  5. Skin
    1. Herpes Zoster

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