Red flags to screen for vertebral fracture in people presenting with low back pain

Han, Christopher S; Hancock, Mark J; Downie, Aron; Jarvik, Jeffrey G; Koes, Bart W; Machado, Gustavo C; Verhagen, Arianne P; Williams, Christopher M; Chen, Qiuzhe; Maher, Christopher G

doi:10.1002/14651858.cd014461.pub2

Cited by 2 publications

(3 citation statements)

References 114 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is reasonable to hypothesise that the prevalence is lower in the primary care setting. Deyo, without providing a specific source, estimated the prevalence at 2 % in primary care [ 3 ], a figure that has subsequently been cited in numerous LBP reviews [ 4 , 7 – 11 , 13 , 14 , 16 , 449 , 451 , 458 , 460 , 487 ], albeit this has never been confirmed in an epidemiological study.…”

Section: Discussionmentioning

confidence: 99%

“…There is limited comprehensive literature on the topic, with the majority of reviews on red flags focussing on spinal pathologies, neglecting extraspinal pathologies [ 36 , 468 , 487 , 488 ]. Reviews addressing extravertebral causes tend to be narrative in nature, lacking a systematic literature search dedicated to extravertebral causes [ 3 , 7 – 11 , 13 , 14 , 37 , 449 , 451 , 458 , 460 ].…”

Section: Discussionmentioning

confidence: 99%

“…Our review, focused on lumbar pain, excluded thoracic pain and treatment complications. The clinical clues for extravertebral LBP identified in our review (Table 33 ) exhibit limited reliability, akin to “red flags” for spinal pathologies [ 35 , 36 , 468 , 487 , 488 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Extravertebral low back pain: a scoping review

Kunow,

Freyer Martins Pereira,

Chenot

2024

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background Low back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered. Methods A systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included. Results The literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes. Discussion Prior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient. Conclusion The differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.

show abstract