According to a survey in 1998, it is estimated that up to 84% of the adults have low back pain at some time in their lives. For many individuals, episodes of low back pain are self-limited and usually subside within 4 to 6 weeks. Patients who continue to have pain beyond the acute period can develop chronic back pain that persist for more than 3 months. The most common risk factors that have been identified to cause low back pain include obesity, smoking, age, female gender, physically strenuous work, sedentary work, low educational attainment, Worker's Compensation insurance, job dissatisfaction, and psychological factors such as somatizations disorder, anxiety, and depression.
Sciatica refers to pain that is characterized by radiating pain from lower back and buttock region along the path of the sciatic nerve coursing through buttock/hips, down the leg up to the foot region. It is often characterized with other symptoms such as numbness, tingling and motor strength weakness. The most common condition that causes sciatica is a bulging disc in the lumbar region, also sometimes referred to as herniated disc that pinches the nerve resulting in swelling and inflammation of the nerve.
Evaluation: A detailed pain history with onset, provocative maneuvers/factors, quality, radiation, site, other associated symptoms, and time course is the most important thing for an initial evaluation. Pertinent family history such as rheumatological disease and other past medical history could also help narrow down the diagnosis.
Physical examination such as a thorough focused lumbar exam, gait assessment, pelvis exam and neurological exam can help narrow down on the differential diagnosis.
Radiographic evaluation such as plain x-rays are generally considered first line. Advanced imaging such MRIs can help substantiate diagnostic secondary to a disc herniation, pinched nerve due to arthritis, or vertebral column instability commonly known as spondylolisthesis, etc.
Laboratory testing may be indicated for conditions that raise suspicion after a thorough history and physical examination. These conditions include rheumatological disease, discitis, metastatic cancer, etc. Lab testing may include CBC, C-reactive protein, ESR, rheumatoid factor, HLA B 27, antinuclear antibodies etc.
Imaging: Plain radiographs such as x-ray should be performed in acute low back pain to exclude fracture, and to assess for spinal instability secondary to spondylosis and spondylolisthesis. MRI or CT may be necessary when history, physical exam findings and plain radiographs are inconclusive.