Identifying Low Back Pain with Neurologic InvolvementExperts are working hard to help sort out types and causes of low back pain (LBP). Around the world, different groups have published clinical decision rules (CDRs). CDRs help doctors diagnose and treat patients with LBP.
In this article, specific attention is paid to LBP from neurologic disease. Three sites were searched for clinical guidelines that included neurologic syndromes. These sites included Medline, the Internet, and published health science journals. Medline is an on-line medical library provided by the National Institutes of Health (NIH).
To be included, the guidelines had to be written in English. They also had to have recommendations for management by primary health care providers. Seven guidelines were found that met the required criteria.
Three groups or categories of LBP with neurologic disease were identified. These included cauda equina syndrome, nerve root syndrome, and spinal stenosis. The authors provide two tables comparing these syndromes as they are presented in each guideline.
In general, there was not agreement among the guidelines. Various opinions were offered about decision factors for diagnosis. There was some agreement and some disagreement about the timing of assessment and predictive value of the diagnostic factors. The greatest amount of agreement was observed in the diagnosis of cauda equina syndrome.
LBP with a neurologic syndrome is less common than LBP from nonspecific causes. But it is also more serious with an increased risk of permanent damage. For this reason, it is important to identify these syndromes as soon as possible.
The authors suggest that a clinical guideline that includes all three of these syndromes is needed. Whenever possible, the specific guidelines need to be based on evidence. Significant predictors of neurologic involvement for each syndrome should be included.
When there is no evidence to support decision making, then group consensus is used. And studies must be done to show if the guidelines are resulting in improved outcomes. The guidelines should also be shown to reduce costs of care for patients with LBP.
Kate Haswell, BSc, MHSc (Hons), PGDipHSc, et al. Clinical Decision Rules for Identification of Low Back Pain Patients with Neurologic Involvement in Primary Care. In Spine. January 2008. Vol. 33. No. 1. Pp. 68-73.
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