Algorithm for Diagnostic Assessment of Low Back Pain and FBSS

An algorithm to investigate low back pain must be based on the likelihood of the diagnosis. In 1995, Schwarzer et al. described the prevalence of the predominant aetiologies in low back pain. To investigate chronic back pain, minimally invasive tests have been developed during the last 15 years and there reproducibility and validity have been well documented (Bog-duk, 2002 b). The quality of the test itself or the expertise of the physician performing the procedure is a necessary but not sufficient condition. The diagnostic must be established according to a clear strategy. Back versus leg pain must first be distinguished when possible and nociceptive differentiated from neuropathic pain. Physical examination will stress signs of radiculopathy versus pseudoradiculopathy. Although differentiating back from leg or radicular pain is particularly difficult to achieve in FBSS, the predominant features will determine the diagnosis process and later the treatment.

In each group, the next step consists in identifying the structure(s) responsible for the pain. The pain generator should be identified. In most non operated patients, a single cause of pain can be identified and treated. In operated patients, we face the possible overlap of multiple sources of pain. When surgery obviously has worsened the situation the question of a second and new pathological condition must be evaluated separately as a separate entity. Pain may be persist despite correct surgery for a correct diagnostic and further surgical treatment is impossible due to postoperative anatomical changes. The worst situation is when new symptoms follow sur

Predominant Low Back Pain

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