Abstract
Introduction
Low back pain imposes a considerable social and economic burden as one of the most serious public health issues in the developed nations and is one of the most common reasons for presentation to primary health-care providers, outpatient, or A&E departments. Currently, point prevalence of acute low back pain adds up to 40%, 1-year prevalence exceeds 70%, and life time prevalence equates 80%. Despite these certainties, the complex set of problems generating low back pain is still not satisfactorily understood. In addition, the complexity of diagnoses and treatment of lumbar pain syndrome provokes insecurity and restraint, especially in younger clinicians when faced with a patient suffering from acute back pain. To counter these problems—alleviating the operational sequences in A&Es, outpatient departments, and health-care centers and minimizing the risk of mis- or underdiagnosis of life-threatening internistic disease patterns, respectively, spinal emergencies—this algorithm has been originated.
Material and Methods
The algorithm is based upon the clinical guidelines of the national and international scientific associations in Europe, North America, and overseas as well as on experienced data in the daily work of the spine specialists at Ludwig-Maximilians-University Munich Campus Großhadern und Innenstadt. Hereby, consistency with the guidelines and recommendations of the literature, on one hand, and feasibility in the course of action in daily life with as much practical relevance as possible, on the other hand, were the main goals.
Results
In synopsis, an algorithm was formed which evaluates the crucial differential diagnosis of lumbar back pain according to their clinical relevance and targets a plot of action in reasonable diagnostic and therapeutic steps. By distinct yes–no decisions within the scope of history taken together with instructions according to clinical, laboratory, and radiological investigational steps, even clinicians without long-time experience in spine surgery should be able to handle patients with acute low back pain in any situation according to the guidelines and treatment needed.
Conclusion
The designated aim in developing this algorithm was to render assistance to colleagues of primary health-care providers, outpatient clinics, and A&E departments by reducing the complexity of diagnosis and treatment of lumbar pain. The aim was also to prevent mis- or underdiagnosis of life-threatening internistic disease patterns or possible spinal emergencies on one side and unnecessary diagnostic and therapeutical actions on the other side. An evaluation of practical application in daily routine will follow over time.