Clinical feature | Potential significance |
Abnormal neurologic findings: - Asymmetric reflexes
- Weakness
- Extensor plantar response
- Low rectal tone*
- Bowel or bladder dysfunction
| - Spinal epidural abscess
- Transverse myelitis
- Spinal cord tumor
- Nerve root compression
|
History of acute or repetitive trauma (particularly lumbar hyperextension) | - Spondylolysis
- Spondylolisthesis
|
Pain that radiates below the buttocks | - Intervertebral disc herniation
- Apophyseal ring fracture
|
Pain that is severe (eg, interferes with activity), constant (unrelated to activity), occurs at night, or is progressive | - Inflammatory arthritis
- Spinal tumor (benign or malignant)
- Spinal cord tumor
- Spinal infection (eg, vertebral osteomyelitis, osteomyelitis, discitis, epidural abscess)
- CNO/CRMO involving the vertebrae or pelvis
- Tethered cord, syringomyelia (in children with severe pain and scoliosis)
- Nephrolithiasis
- Vaso-occlusive pain in children with sickle cell disease
|
Fever | - Spinal or paraspinal infection (eg, osteomyelitis, epidural abscess)
- Extraspinal infection (eg, pneumonia, pyelonephritis, viral infection with myalgia)
- Pancreatitis
- Cholecystitis
|
Fever and weight loss or other systemic findings | - Malignant tumors (eg, leukemia, lymphoma, Langerhans cell histiocytosis, Ewing sarcoma)
- Inflammatory bowel disease-associated arthritis
|
Morning stiffness that lasts longer than 30 minutes | |
History of malignancy | |
History of exposure to tuberculosis | - Tuberculous spondylitis (Pott disease)
|
<10 years | - Increased concern for:
- Malignancy (eg, leukemia, Langerhans cell histiocytosis)
- Infection (eg, osteomyelitis, discitis)
|