musculoskeletal and connective tissue disorders
Evaluation of Neck and Back Pain
Key Points
Low back pain affects 50% of adults>60. Most neck and back pain is caused by mechanical spinal disorders, usually nonspecific, self-limited musculoskeletal derangements. Back pain is often multifactorial, making identification of a specific etiology difficult. Most mechanical disorders are treated with analgesics, early mobilization, and exercises; prolonged bed rest and immobilization are avoided. In patients with acute nonradicular back pain, treatment can be started without extensive evaluation to identify a specific etiology. Although serious spinal or extraspinal disorders are unusual causes, red flag findings often indicate the need for testing. Evaluation of spinal cord function during physical examination includes tests of sacral nerve function (eg, rectal tone, anal wink reflex, bulbocavernosus reflex), knee and ankle jerk reflexes, and motor strength. Patients with segmental neurologic deficits suggesting spinal cord compression require MRI or CT myelography as soon as possible. Abdominal aortic aneurysm should be considered in any older patient with low back pain that is not clearly mechanical, even if no physical findings suggest this diagnosis. 