How often is low back pain not coming from the back?

Area of Science:

• Orthopedics
• Pain Management
• Spine Surgery

Background:

• Identifying the primary pain generator in low back pain (LBP) is challenging.
• Potential pain sources include the lumbar spine, sacroiliac (SI) joint, and hip joint.
• The relative frequencies of these pain generators in LBP patients at spine clinics are not well-established.

Purpose of the Study:

• To determine the relative frequencies of the spine, SI joint, and hip joint as primary pain generators in patients presenting with LBP to a spine surgery clinic.

Main Methods:

• A consecutive case series cohort of 368 new patients at a single spine surgeon's clinic.
• 289 patients (78.5%) primarily complained of LBP with or without leg pain.
• 200 cases were reviewed for diagnostic tests and final diagnoses.

Main Results:

• Spine pathology was found in 164 patients (82%), with 130 (65%) having spine-only pathology.
• 35 patients (17.5%) had combined spine and hip/SI joint pathology.
• 16 patients (8%) had hip/SI joint pathology without spine involvement; 25% had hip pathology and 29% had SI joint pathology.

Conclusions:

• Up to 25% of LBP patients presenting to spine clinics may have significant pain from hip or SI joints.
• An additional 10% may have an undefined pain source post-workup.
• Clinicians should consider non-spinal pain generators and pursue alternative diagnoses for LBP.