Special Studies for Delayed Recovery
After the first month of symptoms, the vast majority of patients have recovered from significant activity limitations due to low back symptoms. However, if the patient's problem is back limitation for more than 1 month, special diagnostic and treatment procedures are often considered to seek either a dangerous or correctable reason for the slow recovery (
Patient Discussion Handout 3).
The special studies are of two kinds. First are tests to provide evidence of compromised bodily function such as neurologic compromise, infection, inflammation, malignancy, or other systemic illness. Second are tests to define a potential correctable reason for the dysfunction such as a herniated lumbar disc, spinal stenosis, infection, tumor, or abdominal mass. As a result of diagnostic considerations, therapeutic interventions including surgery may be recommended.
Except for suspected serious underlying pathology (
Red Flags), special diagnostic tests are usually not needed during the first month.
When special studies are performed the patient should be made aware that the goal is not to find the elusive cause of back symptoms but to seek potentially serious problems and that on imaging studies should expect to find degenerative changes at early age (Carragee`05). Moreover, it is not possible to predict early on which patients will and will not improve during this period. But those few who are not improving at 1 month may include some who could benefit from specific correctable interventions. Waiting longer to start the a diagnostic workup may complicate the patient's employment by delaying recovery for these individuals. The workup is directed by review of the Red Flags and whether there is evidence of any neurological compromise or not (See
Diagnostic Considerations for Delayed Recovery).
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