The diagnosis is usually made on the basis of the medical history and physical examination. Only when warning signs (red flags; see Symptoms – Complaints below) occur, such as increased pain at night, or fever or paralysis, is more extensive medical device diagnostics necessary.
In patients with persistent activity-limiting or progressive low back pain (after four to six weeks) despite guideline-based therapy, the indication for diagnostic imaging should be reviewed.
If warning signs (“red flags”) are present, further imaging or laboratory tests and/or referral to specialist care should be initiated, depending on the suspected diagnosis and urgency.
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnostic clarification.
- X-rays of the affected spinal segments, in two planes – if fractures (bone fractures) are suspected, etc.; if spondylolisthesis (spondylolisthesis) is suspected 45 ° lumbar spine oblique images.
- Computed tomography (CT; sectional imaging method (X-ray images from different directions with computer-based evaluation)) of the spine (spinal CT) – on suspicion of disc herniation, Kauda syndrome, tumors, inflammation.
- Magnetic resonance imaging (MRI; computer-assisted cross-sectional imaging (using magnetic fields, that is, without X-rays)) of the spine (spinal MRI) – on suspicion of disc herniation, Kauda syndrome, tumors, inflammation.
- Skeletal scintigraphy (nuclear medicine procedure that can represent functional changes in the skeletal system, in which regionally (locally) pathologically (pathologically) increased or decreased bone remodeling processes are present) – on suspicion of tumors / metastases or bone infections (inflammatory processes).
- Myelography (radiological contrast imaging of the spine and the spinal canal / vertebral canal) – in unclear stenoses (narrowing).
- Electromyography (EMG; measurement of electrical muscle activity)/nerve conduction velocity (NLG; only positive after 14 days of latency!) – if nerve damage is suspected.
- Osteodensitometry (bone density measurement) – if osteoporosis is suspected.
- 3D spine measurement – provides information about anatomical changes in the back and spine without exposure to radiation. It captures the interrelationships of the spine, pelvis and back, providing an accurate picture of body statics.
- Esophagogastroduodenography (endoscopy of the esophagus, stomach and duodenum) – for suspected duodenal ulcer (duodenal ulcer).
- Sonography (ultrasound examination) – on suspicion of aortic aneurysm (outpouching (aneurysm) of the aorta).
- Electrocardiogram (ECG; recording of the electrical activity of the heart muscle) – in acute back pain to exclude ST elevation myocardial infarction (myocardial infarction).
Notice:
- No imaging for low back pain during the first six weeks unless there are red flags.
- Early imaging (radiography, computed tomography, or magnetic resonance imaging) as a diagnostic measure in older adults (>65 years of age) with an initial visit for low back pain provided no benefit for pain status or disability level at three, six, or 12 months except in patients with warning signs (red flags; see below Low Back Pain/Symptoms – Complaints) such as radiculopathy (radiculitis; root neuritis; root syndrome)/neurologic symptoms.
