Low back pain: an algorithmic approach to diagnosis and management

Low back pain may be of local origin, referred to the spine, or associated with pain in the lower limbs. This review discusses the pathophysiology, clinical presentation, and differential diagnosis of acute low back pain and proposes an algorithmic approach to investigation and management. The proportion of patients with serious underlying causes (e.g., cancer, infection, fracture) increases with age, and clinical assessment is directed at identification of these disorders. Most patients have nonspecific findings, do not require special investigation, and respond well to conservative treatment. Patients with suspicious features on history and physical examination require further investigation and individualized management.