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Ankylosing spondylitis is discussed in Chapter 282, “Systemic Rheumatic Diseases.”


Patients presenting with low back pain account for 3% of all ED visits in the United States.1 Nearly one third of ED back pain patients receive radiographs, and 10% undergo CT or MRI imaging.2 Analysis of the 2010 Global Burden of Disease study reveals a point prevalence of 5% for low back pain and 9% for neck pain. Back pain is the number one cause of disability in the United States; neck pain is number four.3,4


There are many causes of neck and back pain, including trauma and biomechanical injuries, degeneration, inflammation (arthritides), infection (e.g., diskitis, meningitis, and epidural abscess), infiltration (e.g., metastatic cancer and spinal cord tumors), and compression (e.g., epidural hematoma and abscess). In many cases of atraumatic neck and back pain, no specific cause can be identified. However, due to the high volume of ED patients with neck and back pain, clinicians can develop an indifference to this complaint and potentially overlook serious causes. Take care to perform a systematic evaluation based on risk factors in the history and physical examination, and let findings guide diagnostic testing and management (Table 279-1). Consider spinal anatomy while focusing on the presence or absence of neurologic signs to identify pathologic causes and prevent complications.

TABLE 279-1Risk Factors for Serious Causes of Neck and Back Pain

Radiculopathy and myelopathy are identified through pattern recognition of the motor and dermatome innervations and their associated spinal level (see Figure 164-1 and Tables 164-1 and 164-2 in Chapter 164, “Neurologic Examination”).


It is helpful to classify patients with neck pain into two groups: those with uncomplicated neck pain arising mainly from the joints, associated ligaments, and muscles of the neck, and those with neck pain and radiculopathy (signs and symptoms attributable to ...

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