Diagnostic Considerations for Low Back Pain

Clinical Presentation and Diagnosis

Nonspecific low back pain is defined as "pain occurring primarily in the back with no signs of a serious underlying condition, spinal stenosis, radiculopathy, or another specific spinal cause" according to the American College of Physicians, with a moderate strength of evidence 1, 2
Degenerative changes on lumbar imaging are usually considered nonspecific as they correlate poorly with symptoms, as stated by the American College of Physicians, with a low strength of evidence 1
Spinal stenosis can cause neurogenic claudication, characterized by leg pain and weakness on walking or standing, relieved by sitting or spinal flexion, as reported by the American College of Physicians, with a moderate strength of evidence 1, 2

Red flags that warrant immediate attention include cauda equina syndrome, signs of spinal infection, and malignancy indicators, as recommended by a medical guideline society, with a high strength of evidence 3