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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Low Back Pain
Richard A. Deyo, James Rainville, Daniel L. Kent
Ankylosing Spondylitis and Spine Range-of-Motion Measures

Topics Discussed: ankylosing spondylitis, back pain, diagnostic process, fractures, compression, low back pain, lower back, spinal neoplasms

Excerpt: "Malignant neoplasm (primary or metastatic) is the most common systemic disease affecting the spine, although it accounts for less than 1% of episodes of low back pain. Approximately 80% of patients with this diagnosis are older than 50 years (Table 7-1). A history of cancer has such high specificity (0.98) that such patients should be considered to have cancer until proven otherwise. However, only one-third of patients with an underlying malignant neoplasm causing their back pain have a prior cancer diagnosis (sensitivity, 0.31). Unexplained weight loss, pain duration greater than 1 month, and failure to improve with conservative therapy are moderately specific findings. Most patients with back pain caused by cancer report that pain is unrelieved by bed rest (sensitivity > 0.90), but the finding is nonspecific.10 In a study of nearly 2000 patients with back pain, no cancer was identified in any patient younger than 50 years and without a history of cancer, unexplained weight loss, or a failure of conservative therapy (combined sensitivity, 100%).10..."
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