Specific Spinal Pathologies in Adult Patients with an Acute or Subacute Atraumatic Low Back Pain in the Emergency Department

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2018 May 31

PMID 29845368

Citations 6

Authors

Aleksi Reito

Kati Kyrola

Liisa Pekkanen

Juha Paloneva

Affiliations

Soon will be listed here.

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Citing Articles

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Characteristics and clinical features of cauda equina syndrome: insights from a study on 256 patients.

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Demographics of Cauda Equina Syndrome: A Population-Based Incidence Study.

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References

Penas-Prado M, Loghin M . Spinal cord compression in cancer patients: review of diagnosis and treatment. Curr Oncol Rep. 2008; 10(1):78-85. DOI: 10.1007/s11912-008-0012-0. View

Donner-Banzhoff N, Roth T, Sonnichsen A, Luckmann J, Leonhardt C, Chenot J . Evaluating the accuracy of a simple heuristic to identify serious causes of low back pain. Fam Pract. 2006; 23(6):682-6. DOI: 10.1093/fampra/cml049. View

Melton 3rd L, Wenger D, Atkinson E, Achenbach S, Berquist T, Riggs B . Influence of baseline deformity definition on subsequent vertebral fracture risk in postmenopausal women. Osteoporos Int. 2006; 17(7):978-85. DOI: 10.1007/s00198-006-0106-1. View

Sorensen J, Hetland M . Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis: results from the Danish nationwide DANBIO registry. Ann Rheum Dis. 2014; 74(3):e12. PMC: 4345887. DOI: 10.1136/annrheumdis-2013-204867. View

van Tulder M, Becker A, Bekkering T, Breen A, Gil Del Real M, Hutchinson A . Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006; 15 Suppl 2:S169-91. PMC: 3454540. DOI: 10.1007/s00586-006-1071-2. View

Henschke N, Maher C, Refshauge K, Herbert R, Cumming R, Bleasel J . Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum. 2009; 60(10):3072-80. DOI: 10.1002/art.24853. View

Waterman B, Belmont Jr P, Schoenfeld A . Low back pain in the United States: incidence and risk factors for presentation in the emergency setting. Spine J. 2011; 12(1):63-70. DOI: 10.1016/j.spinee.2011.09.002. View

Schoenfeld A, Bader J . Cauda equina syndrome: an analysis of incidence rates and risk factors among a closed North American military population. Clin Neurol Neurosurg. 2012; 114(7):947-50. DOI: 10.1016/j.clineuro.2012.02.012. View

Podnar S . Epidemiology of cauda equina and conus medullaris lesions. Muscle Nerve. 2006; 35(4):529-31. DOI: 10.1002/mus.20696. View

10.

Chou R, Qaseem A, Snow V, Casey D, Cross Jr J, Shekelle P . 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. 2007; 147(7):478-91. DOI: 10.7326/0003-4819-147-7-200710020-00006. View

11.

Verhagen A, Downie A, Popal N, Maher C, Koes B . Red flags presented in current low back pain guidelines: a review. Eur Spine J. 2016; 25(9):2788-802. DOI: 10.1007/s00586-016-4684-0. View

12.

Todd N, Dickson R . Standards of care in cauda equina syndrome. Br J Neurosurg. 2016; 30(5):518-22. DOI: 10.1080/02688697.2016.1187254. View

13.

Thiruganasambandamoorthy V, Turko E, Ansell D, Vaidyanathan A, Wells G, Stiell I . Risk factors for serious underlying pathology in adult emergency department nontraumatic low back pain patients. J Emerg Med. 2014; 47(1):1-11. DOI: 10.1016/j.jemermed.2013.08.140. View

14.

Kehrer M, Pedersen C, Jensen T, Lassen A . Increasing incidence of pyogenic spondylodiscitis: a 14-year population-based study. J Infect. 2013; 68(4):313-20. DOI: 10.1016/j.jinf.2013.11.011. View

15.

Johnsson K, Sass M . Cauda equina syndrome in lumbar spinal stenosis: case report and incidence in Jutland, Denmark. J Spinal Disord Tech. 2004; 17(4):334-5. DOI: 10.1097/01.bsd.0000095828.98982.6c. View

16.

Gardner A, Gardner E, Morley T . Cauda equina syndrome: a review of the current clinical and medico-legal position. Eur Spine J. 2011; 20(5):690-7. PMC: 3082683. DOI: 10.1007/s00586-010-1668-3. View

17.

Sobottke R, Seifert H, Fatkenheuer G, Schmidt M, Gossmann A, Eysel P . Current diagnosis and treatment of spondylodiscitis. Dtsch Arztebl Int. 2009; 105(10):181-7. PMC: 2696793. DOI: 10.3238/arztebl.2008.0181. View