Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain

Epidemiologic studies document the overuse of surgical procedures in the United States compared with rates in 11 developed countries. Delay in return to work remains an expensive component in the cost of low back pain for workers' compensation claims. Injury to spinal nerve roots may occur secondary to compression with intraradicular edema or from inflammatory phenomena related to phlogistic properties of the nucleus pulposus, independent of nerve compression. Magnetic resonance imaging findings of intervertebral disk bulging and protrusion occur frequently in asymptomatic individuals. Reviews of adult scoliosis, postpartum back pain, diabetic radiculopathy, insufficiency fractures of the sacrum, diskitis, and facet syndrome have appeared in the literature over the past year. Patient education and minimal limitation of activity are associated with the greatest level of patient satisfaction. Long-term follow-up studies of surgical decompression for intervertebral disk herniation and spinal stenosis have resulted in good outcomes in appropriately selected patients.