Back pain DDx

Back pain – Differential Diagnosis

Common causes

Must Not Miss

Easily missed

Red flags

  • Cauda equina syndrome
    • Bilateral Sciatica
    • Saddle anaesthesia
    • Bladder or bowel dysfunction
    • Major motor weakness
    • Gait problems (e.g. foot drop)
  • Thoracic pain
  • Major recent trauma
    • (RTA, fall from a height)
  • Minor trauma or lifting in people with Osteoporosis
  • Age >50 years or <20 years
  • History of Cancer, HIV, Drug abuse
  • Constant, progressive or night pain disturbing sleep
  • Systemic symptoms
    • (fever, night sweat, weight loss)
  • Immunosuppression
    • (HIV, Chemotherapy, Steroids)

Investigations to consider

  • FBC, CRP/ESR
  • U&Es, LFTs, Bone profile
  • Auto antibody screen
  • Myeloma screen
  • PSA
  • Urinalysis
  • X-ray Spine
  • MRI scan
  • Bone scan
  • CXR, CT chest/ abdo & pelvis