Low Back Pain Medical Clinics Anna L. Golob, MD, Joyce E. Wipf, MD  Medical Clinics  Volume 98, Issue 3, Pages 405-428 (May 2014) DOI: 10.1016/j.mcna.2014.01.003 Copyright © 2014 Terms and Conditions

Fig. 1 Anatomy of the lumbar spine. (A) Cross-sectional view through a lumbar vertebra. (B) Lateral view of the lumbar spine. (From Firestein GS, Budd RC, Gabriel SE, et al. Kelley’s textbook of rheumatology. Philadelphia: Saunders; 2013. p. 666; with permission.) Medical Clinics 2014 98, 405-428DOI: (10.1016/j.mcna.2014.01.003) Copyright © 2014 Terms and Conditions

Fig. 2 Spondylosis and scoliosis of the lumbar spine. Anteroposterior and lateral radiographs of the lumbar spine showing mild levoconvex scoliosis with apex L2/3, multilevel disc space narrowing, endplate spurring, and lumbar facet arthropathy. Medical Clinics 2014 98, 405-428DOI: (10.1016/j.mcna.2014.01.003) Copyright © 2014 Terms and Conditions

Fig. 3 Schematic drawing showing posterolateral disc herniation resulting in nerve root impingement. (From Firestein GS, Budd RC, Gabriel SE, et al. Kelley’s textbook of rheumatology. Philadelphia: Saunders; 2013. p. 670; with permission.) Medical Clinics 2014 98, 405-428DOI: (10.1016/j.mcna.2014.01.003) Copyright © 2014 Terms and Conditions

Fig. 4 Disc bulge. (A) T1-weighted sagittal and (B) T2-weighted axial MRI showing diffuse disc bulges at levels L3-4 and L4-5 (thin arrows) and posterior central disc extrusion at L5-S1 (thick arrow) resulting in narrowing of the left lateral recess that contacts the traversing left S1 nerve root. Medical Clinics 2014 98, 405-428DOI: (10.1016/j.mcna.2014.01.003) Copyright © 2014 Terms and Conditions

Fig. 5 Degenerative spinal stenosis. (A) T1-weighted sagittal and (B) T2-weighted axial MRI showing severe dural compression at L2-3 (arrow) secondary to severe facet and ligamentum flavum hypertrophy and circumferential disc bulge with caudal extension of the central disc extrusion. Severe dural compression at L3-4 and moderate dural compression at L4-5. Medical Clinics 2014 98, 405-428DOI: (10.1016/j.mcna.2014.01.003) Copyright © 2014 Terms and Conditions

Fig. 6 (A) Spondylolysis with bilateral defects in the pars interarticularis (arrows). (B) Spondylolysis of the L5 vertebra (arrow) resulting in isthmic spondylolisthesis at L5-S1. (From Firestein GS, Budd RC, Gabriel SE, et al. Kelley’s textbook of rheumatology. Philadelphia: Saunders; 2013. p. 672; with permission.) Medical Clinics 2014 98, 405-428DOI: (10.1016/j.mcna.2014.01.003) Copyright © 2014 Terms and Conditions

Fig. 7 Spondylolisthesis. T1-weighted sagittal MRI showing grade 1 anterolisthesis of L4 on L5, likely degenerative. Medical Clinics 2014 98, 405-428DOI: (10.1016/j.mcna.2014.01.003) Copyright © 2014 Terms and Conditions

Fig. 8 Straight leg raising test. (From Levin KH, Covington EC, Devereaux MW, et al. Neck and back pain. Continuum: Lifelong Learning Neurol 2001;7:20; with permission.) Medical Clinics 2014 98, 405-428DOI: (10.1016/j.mcna.2014.01.003) Copyright © 2014 Terms and Conditions

Fig. 9 Neurologic features of lumbosacral radiculopathy. (From Firestein GS, Budd RC, Gabriel SE, et al. Kelley’s textbook of rheumatology. Philadelphia: Saunders; 2013. p. 668; with permission.) Medical Clinics 2014 98, 405-428DOI: (10.1016/j.mcna.2014.01.003) Copyright © 2014 Terms and Conditions

Fig. 10 Algorithm for the evaluation of low back pain. CRP, C-reactive protein; ESR, Erythrocyte sedimentation rate. (Adapted from Wipf JE, Deyo RA. Low back pain. Common medical problems in ambulatory care. Med Clin North Am 1995;79:239; with permission.) Medical Clinics 2014 98, 405-428DOI: (10.1016/j.mcna.2014.01.003) Copyright © 2014 Terms and Conditions

Fig. 11 Keele STarT back screening tool. Keele STarT back tool. (Courtesy of Keel University, Keele, Staffordshire, UK; with permission. The copyright (©2007) of the STarT Back Tool and associated materials is owned by Keele University, the development of which was part funded by Arthritis Research UK: i) the tool is designed for use by health care practitioners, with appropriate treatment packages for each of the stratified groups;ii) the tool is not intended to recommend the use of any particular product. No license is required for non-commercial use. If you would like to incorporate the tool in any way into commercial product materials, please contact Keele University for further advice.) Medical Clinics 2014 98, 405-428DOI: (10.1016/j.mcna.2014.01.003) Copyright © 2014 Terms and Conditions

Fig. 12 Scoring the Keele STarT back screening tool. “Psych score” refers to score on questions 5 to 9. (Courtesy of Keel University, Keele, Staffordshire, UK; with permission. The copyright (2007) of the STarT Back Tool and associated materials is owned by Keele University, the development of which was part funded by Arthritis Research UK: i) the tool is designed for use by health care practitioners, with appropriate treatment packages for each of the stratified groups; ii) the tool is not intended to recommend the use of any particular product. No license is required for non-commercial use. If you would like to incorporate the tool in any way into commercial product materials, please contact Keele University for further advice.) Medical Clinics 2014 98, 405-428DOI: (10.1016/j.mcna.2014.01.003) Copyright © 2014 Terms and Conditions