Specific causes of back pain: some ideas from European Guidelines for the management of Chronic non specific back pain (2004)
There is little relationship between low back pain symptoms, pathology and radiological findings.
In 85% of people (Deyo 1988), pain has no relationship to any time of physical abnormality.
*4% of people seen with low back pain in primary care have compression fractures
*1% have a neoplasm (Deyo et al 1992).
*5% develop at least one vertebral fracture in 4 years (Kado et al 2003).
Spondylarthropathies have been reported to occur at a rate of 0.8 to 1.9% of the general population (Saraux et al 1999).
Spinal infections are rare, and chronic spinal infections are particularly rare. Infectious diseases of the spine should be considered if the patient has fever, has had previous surgery, has a compromised immune system, or is a drug addict.
Spondylolysis and spondylolisthesis are often classified as non-specific low back pain because a considerable proportion of patients with such anatomic abnormalities are asymptomatic (Soler and Calderon 2000)
Back and leg pain after surgery represent a major problem addressed at specific conferences for failed back surgery.
Failure rates range from 5-50%. Based on a failure rate of 15%, it was estimated that 37500 new patients with failed back surgery syndrome would be generated annually in the US (Follet and Dirks 1993).
One of the causes that is consistently reported in the literature includes poor patient selection (Goupille 1996, Van Goethem et al 1997).
“This means that patients with non-specific back pain are operated on for radiologically diagnosed disc bulging, herniation or degeneration, which turn out not to be responsible for their pain.”
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