A diagnostic approach

A summary of the safety diagnostic model is presented in Table 33.2 . Table 33.2 Low back pain: diagnostic strategy model

Q. Probability diagnosis

A Vertebral dysfunction esp. facet joint and disc

. Spondylosis (degenerative OA)

Q. Serious disorders not to be missed


• ruptured aortic aneurysm

• retroperitoneal haemorrhage (anticoagulants) Neoplasia

• metastases Severe infections

• osteomyelitis

• tuberculosis

• pelvic abscess/PID Cauda equina compression

Q. Pitfalls (often missed)


ankylosing spondylitis

• Reiter's disease

• bowel inflammation Sacroiliac dysfunction Spondylolisthesis Claudication

• neurogenic Prostatitis Endometriosis

Q. Seven masquerades checklist

Depression x

Thyroid disease

Spinal dysfunction x


Q. Is this patient trying to tell me something?

A. Quite likely. Consider lifestyle, stress, work problems, malingering, conversion reaction

Note: Associated buttock and leg pain included.

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