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.

Back Pain Revealed

Back Pain Revealed

Tired Having Back Pains All The Time, But You Choose To Ignore It? Every year millions of people see their lives and favorite activities limited by back pain. They forego activities they once loved because of it and in some cases may not even be able to perform their job as well as they once could due to back pain.

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