Acute back pain: clinical and radiological diagnosis. Guidelines of the WFNS Spine Committee

Abstract

Aim. To propose the list of guidelines of the World Federation of Neurosurgical Societies (WFNS) Spine Committee on clinical and radiological diagnosis of acute back pain.Materials and methods. Systematic literature search in the PubMed and Google Scholar databases between 2012 and 2022 using keywords “acute back pain AND clinical diagnosis” and “acute back pain AND radiologic diagnosis” was performed. In total, 97 articles were analyzed, and the WFNS Spine Committee organized 2 consensus meetings to propose specific guidelines. The first meeting took place in May of 2022 in Karachi (Pakistan), the second during the Congress of the Middle East Spine Society in September of 2022 in Istanbul (Turkey). To formulate the guidelines, both meetings used the Delphi method of voting on the preliminary statements proposed based on the evidence level‑stratified literature search.Results and discussion. In total, 10 statements were put to vote. Clinical characteristics allowing to distinguish between acute and chronic pain were indicated. A trend towards instrumental hyperdiagnosis of back pain was observed but routine neuroimaging does not have clinical benefit in acute back pain, it can even have a negative effect.Conclusion. Acute back pain is hard to diagnose both clinically and radiologically. A patient with primary acute back pain should not be prescribed radiological exams in the absence of “red flags”. There are specific indications for specific radiological exams. The gold standard of diagnosis is magnetic resonance imaging which is confirmed by high‑quality studies.