Back pain

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By Richard S Polin MD

Back pain remains an evolving and controversial topic in modern medicine and a multidisciplinary field that involves specialists in neurology, neurosurgery, orthopedic surgery, rheumatology, physiatry, and occupational medicine. In this clinical article, the author discusses the literature concerning surgery versus nonoperative care for discogenic back pain.

Key points

  • Lumbar pain is multifactorial and entails great societal costs.
  • Conservative care including anti-inflammatory therapy and physical therapy should be the first treatment unless trauma, infection, or tumor is suspected.
  • Surgical approaches to back pain are controversial unless overt instability is apparent.

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited