Assessment Of LBP

Secondary Assessment of Low Back Problems
The purpose of the secondary assessment in current algorithms is to determine the reason for delayed recovery in a patient who has not symptomatically or functionally improved after one month of initial treatment (i.e., the patient has progressed to a subacute low back problem).

The first step in secondary assessment is a re-evaluation with assignment of the patient into one of the five same clinical categories (as in the initial phase):


Conditions involving the bony spinovertebral axis such as cancer, infection or fracture;


Intraspinal pathology involving the neuraxis such as cauda equina syndrome or radiculopathy;


Arthritic or inflammatory conditions;


Mechanical conditions; or


Referred low back pain due to viscerogenic and/or other causes.

Depending on the findings, diagnostic evaluation during the subacute phase (one to three months) may include diagnostic imaging, laboratory tests, bone scan, electrophysiologic tests, functional capacity testing, ergonomic evaluation and/or psychological testing.



Secondary Assessment Methods are as follows:
(Medical Services Department; Work. Compensation Board)

bullet Plain film x-rays (AP and lateral views)
bullet Specialized imaging tests - CT, MRI, Myelography and CT- Myelography
bullet Bone scan
bullet Laboratory testing
bullet EMG - conduction study
bullet Functional capacity testing
bullet Ergonomic evaluation
bullet Psychiatric evaluation and/or appropriate psychological testing
bullet DSSEP




Secondary or Intermediate Treatment of Low Back Problems – Sub Acute Phase
(Medical Services Department; Work. Compensation Board)
bullet Education
bullet Activity Modification
bullet Exercise
bullet Drug therapy
bullet Physical Treatments
bullet TENS
bullet Acupuncture
bullet Epidural Injections
bullet Myofacial Trigger point Injections
bullet Discectomy / Laminectomy
bullet Spinal Fusion

The aim of ‘secondary (intermediate) treatment’ is to provide appropriate symptomatic relief of pain for the patient and prevent progressive deconditioning and permanent disability, while promoting return to function and work for those who are either off work or on modified duty. Treatment is based on the findings of the diagnostic re-evaluation at four weeks. This phase of treatment may be extended up to two months beyond the initial phase of treatment.

The list of suggested treatments in the Sub-acute phase of treatment is identical to the list of treatments suggested in the initial phase, with the addition of biofeedback and surgical procedures.




in Surgical Treatment section of Physicians Forum





Spine Medical Center



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