Conditions Neck/Back pain

Localized lower back pain of variable severity that may refer into buttocks or thighs without a clear radicular pattern and is aggravated by movement . Imaging is not routinely indicated without red flags . Physical exam reveals paraspinal tenderness, muscle tightness, spasm, pain with movement, decreased range of motion, and a normal neurologic examination

Non Specific Low Back Pain

Shooting, burning, or electric pain radiating into the lower extremity that is worsened by coughing, sneezing, or pressure . MRI is indicated for persistent symptoms or progressive deficits . Physical exam reveals numbness, weakness, or sensory deficits in a nerve root distribution, with a positive straight leg raise test, crossed straight leg raise test, or slump test

Lumbosacral Radiculopathy

Unilateral radiating leg pain or sciatica that is worsened by lumbar flexion, prolonged sitting, coughing, or sneezing . MRI shows disc material displacement compressing the traversing or exiting spinal nerve root . Physical exam reveals a positive straight leg raise test, sensory changes, motor weakness, or diminished reflexes

Lumbar Disc Herniation

Low back pain accompanied by neurogenic claudication with leg pain, heaviness, numbness, or weakness provoked by walking or standing and relieved by sitting or leaning forward . MRI reveals narrowing of the spinal canal or neural foramina from disc bulging, facet hypertrophy, or ligamentum flavum thickening . Physical exam is often normal at rest with symptom relief during lumbar flexion

Lumbar Spinal Stenosis

Chronic low back pain and stiffness that worsens with activity and improves with rest in an older adult . Radiographs reveal disc space narrowing, osteophytes, and facet arthropathy . Physical exam reveals decreased lumbar range of motion and spinal stiffness without focal neurologic deficits

Lumbar Spondylosis

Low back pain with or without radicular symptoms that is aggravated by movement and standing . Standing radiographs or MRI demonstrate anterior displacement of one vertebra relative to another . Physical exam reveals a palpable step off on spinal palpation, hamstring tightness, or nerve root compression signs

Lumbar Spondylolisthesis

Severe low back pain with bilateral radicular pain, new urinary retention, bowel dysfunction, or incontinence . Emergent MRI demonstrates compression of multiple lumbosacral nerve roots below the spinal cord termination . Physical exam reveals saddle anesthesia, lower extremity weakness, sensory deficits, and decreased reflexes

Cauda Equina Syndrome

Abrupt onset of severe back pain, early bowel and bladder dysfunction, symmetric motor or sensory deficits, and sexual dysfunction . Emergent MRI demonstrates injury or compression of the terminal spinal cord near the L1 or L2 level . Physical exam reveals saddle anesthesia, symmetric weakness, and mixed upper and lower motor neuron signs such as hyperreflexia, spasticity, or a positive Babinski sign

Conus Medullaris Syndrome

Persistent localized back pain with or without fever in a patient with risk factors such as diabetes, immunosuppression, or injection drug use . X rays show endplate erosion or disc space narrowing, while MRI with contrast is the imaging of choice . Physical exam reveals focal midline vertebral tenderness to palpation or percussion, with potential neurologic deficits

Vertebral Osteomyelitis or Discitis

Classic triad of severe localized back pain, fever, and progressive neurologic deficits . Contrast MRI demonstrates a collection of infected fluid in the spinal epidural space . Physical exam reveals focal spinal tenderness, radicular weakness, sensory loss, or bowel and bladder dysfunction

Spinal Epidural Abscess

Persistent progressive back pain unrelieved by rest, worsening at night, history of malignancy, and unexplained weight loss . Whole spine MRI demonstrates a vertebral or epidural lesion compressing the spinal cord or nerve roots . Physical exam reveals localized vertebral tenderness and progressive motor weakness or sensory deficits

Metastatic Spinal Cord Compression

Localized acute back pain following minor trauma or movement in an older adult or patient with osteoporosis or chronic glucocorticoid use . Radiographs reveal loss of vertebral body height, MRI assesses acuity, and DEXA evaluates bone density . Physical exam reveals focal vertebral point tenderness, loss of height, and progressive kyphosis without focal neurologic deficits

Vertebral Compression Fracture

Insidious onset of chronic inflammatory back pain in a patient under age forty five, with morning stiffness that improves with exercise but not rest . Pelvic radiographs show sacroiliitis, while advanced disease shows vertebral squaring, syndesmophytes, and bamboo spine . Physical exam reveals reduced spinal mobility in all planes, sacroiliac joint tenderness, and forward stooped posture

Ankylosing Spondylitis

Asymptomatic congenital failure of posterior vertebral arch fusion, often discovered incidentally . Ultrasound or MRI demonstrates failure of vertebral arch fusion without displacement of the spinal cord or meninges . Physical exam reveals overlying skin findings such as a sacral dimple, hair tuft, hemangioma, or subcutaneous lipoma

Spina Bifida Occulta

Progressive lower back or leg pain, gait abnormalities, weakness, sensory changes, and neurogenic bladder or bowel dysfunction . MRI demonstrates a low lying conus medullaris or abnormal spinal cord attachment to the spinal canal . Physical exam reveals lower extremity weakness, sensory changes, gait disturbance, foot deformities, or scoliosis

Tethered Cord Syndrome

Localized low back pain in an adolescent athlete, worsening with lumbar extension and repetitive rotational activity . Oblique radiographs demonstrate a Scotty dog collar defect representing a pars interarticularis fracture . Physical exam reveals point tenderness over the lumbar spine, pain provoked by lumbar extension, and hamstring tightness

Spondylolysis

Asymptomatic spinal asymmetry noted in a child or adolescent during routine physical screening . Standing full length spine radiographs demonstrate a Cobb angle of ten degrees or greater . Physical exam reveals uneven shoulders, hips, or waistline, and a rib hump or trunk asymmetry on the Adam forward bend test

Scoliosis

Neck pain and stiffness following overuse, repetitive movement, or rapid acceleration deceleration trauma . Cervical spine X rays are typically normal or show loss of lordosis from muscle spasm . Physical exam reveals spinous process or paraspinal muscle tenderness, spasm, and decreased cervical range of motion without neurologic deficits

Cervical Strain or Whiplash

Sharp, burning, or electric pain radiating down the arm, accompanied by paresthesias, numbness, or weakness in a dermatome distribution . MRI demonstrates cervical disc herniation or foraminal stenosis compressing a nerve root . Physical exam reveals sensory loss, motor weakness, diminished reflexes, and a positive Spurling test

Cervical Radiculopathy

Hand clumsiness, difficulty with fine motor tasks, gait instability, and balance problems . Cervical MRI demonstrates spinal cord compression and cord signal changes within the spinal canal . Physical exam reveals upper motor neuron signs including hyperreflexia, clonus, a positive Hoffmann sign, a positive Babinski sign, and a spastic gait

Cervical Myelopathy

Arm and hand pain, paresthesias, or weakness, aggravated by overhead activity, with possible upper extremity swelling, coolness, or discoloration . Radiographs may reveal a cervical rib or abnormal bony anatomy . Physical exam reveals hand muscle atrophy, sensory deficits, or diminished upper extremity pulses and vascular changes

Thoracic Outlet Syndrome

Gradual onset of groin, thigh, or buttock pain, worsening with weightbearing and progression to rest pain, in a patient with corticosteroid or heavy alcohol use . Radiographs reveal sclerosis, cystic changes, femoral head flattening, or a crescent sign, while MRI is the most sensitive early test . Physical exam reveals decreased hip range of motion, especially internal rotation, and an antalgic gait or limp

Avascular Necrosis of the Femoral Head