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Diagnosis and Management of Acute Low Back Pain

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.

CT = computed tomography; MRI = magnetic resonance imaging; ESR = erythrocyte


sedimentation rate; WBC = white blood cell.

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