Cord compression	Epidural abscess	Cauda equina	Ankylosing spondylitis	Disk herniation
Hx	History of cancer	Fever, high ESR	Bowel and bladder incontinence, erectile dysfunction	Under age 40, pain worsens with rest and improves with activity	Pain/numbness of medial calf or foot
PEx	Vertebral tenderness, sensory level, hyperreflexia	Same as cord compression	Bilateral leg weakness, saddle area anesthesia	Decreased chest mobility	Loss of knee and ankle reflexes, positive straight leg raise
X-ray	may be ⊖	may be ⊖	ⓝ	Bomboo sign
Dx	MRI	·       ⊕ inflammatory markers + fever ·       ⊕ MRI	MRI Confirms	Clx / Abs /
Tx	1˚ STEROIDs then go to surgery	Abx + drainage	Surgery		·       NSAIDs / Acetaminophen

	Causes	Clx
MSK	Mechanical (muscle strain, spasm, degenerative arthritis)	·       ⓝ neurologic examination ·       ⊖ straight leg raise ·       paraspinal tendemess
	Herniated nucleus pulposus/ disk disease	·       Radiculopathy (usually L4-L5) ·       ⊕straight leg raise ·       ⊕ neurologic signs
	Spinal stenosis	·       Pseudoclaudication ·       Better with spine flexion ·       Worse With extension ·       Older age
	Cornpression fx	·       Older age ·       More cornmm in wornen ·       Trauma/fall (may be minor)
Inflammatory	·       Ankylosing spondylitis ·       reactive afiritis, ·       psoriatic arthritis, ·       inflammatory bowel disease	·       Better with activity or exercise ·       No improvement with rest ·       Gradual onset ·       HLA-B27 present
Metastatic	Cancer metastasis to bones	·       PMHx of malignancy ·       Worse at night ·       Unintentional weight loss ·       Cauda equina syndrome (weakness, urine retention/incontinence, saddle anesthesia)
Infectious	Osteomyelitis	·       Fever, ·       Severe pain at a specific point ·       IVDU ·       Recent infection

	Causes of chronic low back pain
Mechanical (muscle strain, disc degeneration)	·       Normal neurologic ·       Paraspinal tendemess
Radiculopathy (herniated disk)	·       Pain radiates below knee ·       ⊕ straight-leg raise
Spinal stenosis	·        Pseudoclaudication ·       Pt reports relief of pain when leaning forward
Inflammatory (spondyloarthropathy)	Worse with rest, better with activity
Metastatic cancer	·       Worse at night ·       Not relieved w/ rest
Infectious (osteomyelitis)	·       Recent infection or IVDU ·       Fever. focal spine tenderness

	Acute Lumbosacral Radiculopathy (Sciatica)
Features	Herniated disk
S/S	Lower back pain, ⊕ raise leg test
Dx	·        Clx → Start tx based on it ·       MRI Confirms dx (would not change initial tx) ·       Indications for MRI: ·       Progressive sensory or motor deficits, ·       Signs of cauda equina syndrome (eg, saddle anesthesia), ·       Concern for epidural abscess (eg, fever, intravenous drug abuse).
Tx	·       Most pts  will experience spontaneous resolution; focus on tx of sx ·       1st-line: NSAIDs / Acetaminophen ·       Activity modification is often advisable, but patients should be encouraged to maintain moderate physical activity.

	Indications for imaging in low back pain
X-ray	·       Osteoporosis ·       Compression Fx ·       Suspected malignancy ·       Ankylosing spondylitis
MRI	·       Sensory/motor deficits ·       Cauda equina syndrome (eg, urine retention, saddle anesthesia) ·       Suspected epidural abscess/infection (fever, intravenous drug abuse, concurrent infection, hemodialysis)
Radionuclide bone scan / CT scan	= MRI but pt can’t have MRI

	Tx of Low back pain
Acute	·       Maintain moderate activity ·       NSAlDs or acetaminophen
Chronic	Exercise therapy (stretching/strengthening, aerobic)
2˚ Prevention	Exercise therapy Education