Lumbalgia: an important situation for a diagnostic delay

Lumbalgia: an important situation for a diagnostic delay

 

Lumbalgia is a very common symptom in clinical practice. Although more than ninety per cent  of the occasions is associated with a benign problem,  the real challenge is to discriminate when an important disease or situation is responsible for the pain.

Patients with some diagnoses associated with lumbalgia are prone to a delay in their diagnosis, including some rare tumor or a vascular problem. The first step to try to improve the diagnosis in this important symptom is to follow a methodical anamnesis and physical examination. The scenario  where a problem associated with lumbalgia  occurs is in the general practice and the Emergency Department, usually a crowded and busy location where it is difficult for doctors to spend time in a complete examination, a situation very common in our days.

Lumbalgia and the worst-case scenario

Prevalence is a logical rule to follow when we have to evaluate a symptom with so many pathologies associated, but to increase the accuracy of our differential, we need to pay attention to some diagnosis that can be life-threatening like spinal cord compression, aortic aneurysm  or infectious spondylitis. Only a high index of suspicious can help to detect on time these clinical situations and to start the correct treatment on time. We are not talking about a 45 minute interview, but a directed and methodical one, paying attention to subtle keys that can orientate until the final diagnosis.

Spinal cord compression

Lumbalgia and satisfaction of search

Lumbalgia itself is not a diagnosis, but in clinical practice this name is taken as a disease. Should we use a more precise anatomical location instead of “lumbalgia”? I believe, yes. When the brain can summarize a problem in a unique word, then this word is used to speed a decision and to stop thinking. Lumbalgia is so common in clinical practice that we lose respect for it , because our mind is prone to think in a benign condition.

There is not a magical solution to detect an important problem in the whole forest of lumbalgia, but the first step must be an orientated anamnesis and physical examination, even during a rush clinical practice or a crowded clinical scenario.

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