Acute Lower Back Pain

Lower back pain is common, with up to 8% of the adult population in the United States reporting at least one episode of acute back pain within the last year. This is associated with considerable burden to the health care system. The majority of patients who experience back pain have no clear etiology for their symptoms; although symptoms tend to improve within 4 to 6 weeks, they also tend to recur. This review covers the pathophysiology, diagnosis and treatment, and disposition and outcomes of acute lower back pain. Figures show magnetic resonance images of L4/L5 disk herniation, spinal neoplasm, and epidural abscess; schematics of cauda equina syndrome associated with central disk herniation and disk herniation causing unilateral radicular symptoms due to nerve root compression; and dermatomal symptoms associated with L4-S1 nerve root compromise. Tables list red flag signs and symptoms of acute back pain, emergent causes of acute back pain, Waddell signs suggestive of nonorganic back pain, neurologic examination findings associated with L1-S1 nerve roots, pros and cons of treatment options for musculoskeletal and radicular back pain, and indications for surgery for patients with spinal epidural abscess and vertebral osteomyelitis. This review contains 5 highly rendered figures, 6 tables, and 98 references.