What is the role of a neurological exam in the diagnosis of low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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A neurological evaluation is performed to determine the presence or absence and levels (if present) of radiculopathy or myelopathy. Anatomical localization is determined by muscle and reflex testing combined with medical history details obtained during the interview and the absence of neurological symptoms or signs that implicate cerebral or brainstem involvement. Consistent myotomal weakness and sensory findings that seem to coincide with segmental radiculopathy or polyradiculopathies should not be ignored.

The neurologist should identify syndromes of the lower motor neurons versus the upper motor neurons and the level of spinal dysfunction. Hyperreflexia in caudal spinal levels may change to reduced or absent reflexes in the upper extremities, determining the radicular or spinal cord localization of dysfunction. Rectal examination is indicated in patients in whom myelopathy, especially cauda equina syndrome, is a diagnostic concern. The tone of the anal sphincter; presence or absence of an anal wink; and correlation with motor, sensory, and reflex findings are appropriate to determine in these cases.

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