Low back pain of disc, sacroiliac joint, or facet joint origin: a diagnostic accuracy systematic review

Han, Christopher; Hancock, Mark J.; Sharma, Sweekriti; Sharma, Saurab; Harris, Ian A.; Cohen, Steven P.; Magnussen, John; Maher, Chris G; Traeger, Adrian C

doi:10.1016/j.eclinm.2023.101960

Cited by 20 publications

(14 citation statements)

References 79 publications

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“…There is substantial overlap and proximity for lumbosacral spine pain, hip pain, piriformis syndrome, superior cluneal pain, middle cluneal nerve pain, ischial tuberosity pain, sacralgia, and pelvic floor pathology. This complex differential and the challenge of ruling in or ruling out these various etiologies has confounded our understanding of SIJ pain prevalence 32 .…”

Section: Physical Examinationmentioning

confidence: 99%

“…MRI is not a primary diagnostic for SIJ pain, and bone scans are controversial. A systematic review by Han et al 32 only found 2 articles using bone scan and did not identify any articles for single-photon emission computed tomography (SPECT) that met their inclusion criteria; however, MRI and SPECT can be useful in diagnosing axial spondyloarthropathy such as ankylosing spondylitis.…”

Section: Imagingmentioning

confidence: 99%

“…Typically, plain films are reviewed for obvious pathology such as spondylolisthesis and flatback syndrome. Lumbar facet disease is much more challenging 32 . A diagnostic medial branch blocks can be helpful, whereas an MRI is commonly used to rule neural compressive pathology.…”

Section: Imagingmentioning

confidence: 99%

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The Sacroiliac Joint

Polly

2024

JBJS Reviews

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» The sacroiliac joint (SIJ) is a common cause of low back pain and should be included in the differential diagnosis.» Nonoperative treatment of sacroiliac pain is always the first line of therapy; however, when it is unsuccessful and becomes chronic, then recurrent nonoperative treatment becomes expensive.» Surgical treatment is cost-effective in appropriately selected patients. High-quality clinical trials have demonstrated statistically and clinically significant improvement compared with nonsurgical management in appropriately selected patients.» Spinal fusion to the sacrum increases degeneration of the SIJ and frequency of SIJ pain.

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Section: Physical Examinationmentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

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The Sacroiliac Joint

Polly

2024

JBJS Reviews

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“…Ten systematic reviews [30][31][32][33][34][35][36][37][38][39], including 32 primary studies, investigated the diagnostic accuracy of demographic, patient history and physical examination findings commonly used in the diagnosis of non-specific low back pain. Only one systematic review performed a meta-analysis [30]. All systematic reviews presented data from mixed-care settings, the majority (17 of 30 primary studies) being from secondary care environments.…”

Section: Non-specific Low Back Painmentioning

confidence: 99%

Diagnosis Value of Patient Evaluation Components Applicable in Primary Care Settings for the Diagnosis of Low Back Pain: A Scoping Review of Systematic Reviews

Mathieu

Pasquier

Descarreaux

et al. 2023

JCM

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Low back pain ranks as the leading cause of years lived with disability worldwide. Although best practice guidelines share a consistent diagnostic approach for the evaluation of patients with low back pain, confusion remains as to what extent patient history and physical examination findings can inform management strategies. The aim of this study was to summarize evidence investigating the diagnostic value of patient evaluation components applicable in primary care settings for the diagnosis of low back pain. To this end, peer-reviewed systematic reviews were searched in MEDLINE, CINAHL, PsycINFO and Cochrane databases from 1 January 2000 to 10 April 2023. Paired reviewers independently reviewed all citations and articles using a two-phase screening process and independently extracted the data. Of the 2077 articles identified, 27 met the inclusion criteria, focusing on the diagnosis of lumbar spinal stenosis, radicular syndrome, non- specific low back pain and specific low back pain. Most patient evaluation components lack diagnostic accuracy for the diagnosis of low back pain when considered in isolation. Further research is needed to develop evidence-based and standardized evaluation procedures, especially for primary care settings where evidence is still scarce.

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“…The intervertebral disc is the most intensively studied and characterized structure in the human spine [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Despite the enormous body of literature demonstrating that disc tissues are a potent source of experimentally induced low back pain [ 23 ], for almost a century, the concept of discogenic pain as a distinct clinical entity has not been well accepted [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Defining the Patient with Lumbar Discogenic Pain: Real-World Implications for Diagnosis and Effective Clinical Management

Lorio¹,

Beall²,

Calodney

et al. 2023

JPM

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There is an enormous body of literature that has identified the intervertebral disc as a potent pain generator. However, with regard to lumbar degenerative disc disease, the specific diagnostic criteria lack clarity and fail to capture the primary components which include axial midline low back pain with or without non-radicular/non-sciatic referred leg pain in a sclerotomal distribution. In fact, there is no specific ICD-10-CM diagnostic code to classify and define discogenic pain as a unique source of pain distinct from other recognized sources of chronic low back pain including facetogenic, neurocompressive including herniation and/or stenosis, sacroiliac, vertebrogenic, and psychogenic. All of these other sources have well-defined ICD-10-CM codes. Corresponding codes for discogenic pain remain absent from the diagnostic coding vernacular. The International Society for the Advancement of Spine Surgery (ISASS) has proposed a modernization of ICD-10-CM codes to specifically define pain associated with lumbar and lumbosacral degenerative disc disease. The proposed codes would also allow the pain to be characterized by location: lumbar region only, leg only, or both. Successful implementation of these codes would benefit both physicians and payers in distinguishing, tracking, and improving algorithms and treatments for discogenic pain associated with intervertebral disc degeneration.

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Low back pain of disc, sacroiliac joint, or facet joint origin: a diagnostic accuracy systematic review

Cited by 20 publications

References 79 publications

The Sacroiliac Joint

The Sacroiliac Joint

Diagnosis Value of Patient Evaluation Components Applicable in Primary Care Settings for the Diagnosis of Low Back Pain: A Scoping Review of Systematic Reviews

Defining the Patient with Lumbar Discogenic Pain: Real-World Implications for Diagnosis and Effective Clinical Management

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