Low back pain emergencies

Low back pain (LBP) is exceedingly common. Most patients with LBP present acutely or subacutely. The clinician is frequently faced with the task of determining whether or not the individual LBP patient has an emergent or soon-to-be-emergent underlying condition. The approach to the patient with acute or subacute LBP includes a search for red fl ags in the history and careful physical and neurological examinations that can indicate the likelihood of an underlying urgent or emergent condition. In the absence of red fl ags, patients can be treated conservatively for 1 month or more without diagnostic testing. Patients who have or develop red fl ags should undergo urgent and sometimes emergent investigation. LBP emergencies include infections (vertebral osteomyelitis and/or epidural abscess), primary and metastatic spine tumors, thoracic aortic dissection (TAD), expansion or rupture of an abdominal aortic aneurysm (AAA), a large lumbar disk protrusion or extrusion with compression of the cauda equina, and thoracolumbar fractures.