TABLE 5 Laboratory and Radiographic Findings in Selected Causes of Low Back Pain
DISEASE OR LABORATORY TESTS RADIOGRAPHS CONDITION
Back strain No abnormalities Usually negative
Radiographs may show incidental
spondylotic changes.
Acute disc If testing is timed properly, Possibly, narrowed intervertebral
herniation positive findings for disc spaces on radiographs electrodiagnostic studies in the presence of root CT and MRI can reveal level and entrapment degree of herniation.
Myelography localizes site of disc
herniation and the presence of root entrapment.
Osteoarthritis ESR and WBC count plus Asymmetric narrowing of joint
differential typically normal space
Sclerotic subchondral bone
Marginal osteophyte formation
Spondylolisthesis No abnormalities Abnormal intervertebral movement
on radiographs obtained with spine in flexion and extension
Radiographs may reveal pars
defect.
Bone scans can reveal pars defect
not visible on radiographs.
Ankylosing ESR may be elevated Radiographs of pelvis are positive
spondylitis for sacroiliac joint sclerosis and Mild anemia possible narrowing. DISEASE OR LABORATORY TESTS RADIOGRAPHS CONDITION
Positive human leukocyte Bone scans are useful for
antigen-B27 assay in 90 demonstrating increased activity in percent of affected patients sacroiliac joints, facets or costovertebral joints.
Infection Elevated ESR; WBC count Radiographs may show vertebral
may be normal end-plate erosion, decreased intervertebral disc height, changes Blood culture or tuberculin indicative Gallium of bony citrate erosionorand scanning indium- test may be positive reactiveleukocyte labeled bone formation. imaging may be positive.
Malignancy Anemia Radiographs may show bony
erosion or blastic lesions.
Increased ESR Bone scans are useful for early
demonstration of blastic lesions.
Prostate-specific antigen or CT localizes cortical lesions earlier
alkaline phosphatase level than radiographs. may be elevated MRI is useful for demonstrating soft tissue tumors involving the spinal cord.
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