Diagnostic modalities for low back pain

Proper treatment of low back pain requires a good understanding of anatomical structures of the lumbar spine, paraspinal muscles, and neurological structures. Clinical judgment, examination, and a detailed history of the initial causative event and progression of the low back pain can help determine the possible pain generator in many cases. There are several other modalities that may further enhance the accuracy of the diagnosis. Although radiological examinations have been known to specifically diagnose most of the structural abnormalities of the lumbar spine, there are some conditions that may require other types of diagnostic interventions, such as facet, selective nerve root, disc, and epidural/spinal injections, and even spinal endoscopy (epiduroscopy). This article will attempt to outline and describe most of these modalities to help a practicing physician identify the most likely pain generator in the lower back and determine the most effective treatment plan to achieve the intended goal.