What is the role of ultrasonography in the workup for mechanical back pain?

Updated: Aug 27, 2020
  • Author: Debra G Perina, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Ultrasonography may be useful if the differential diagnosis includes appendicitis, a pathologic pelvic process, or abdominal aneurysm. [44]

True emergencies that necessitate imaging include the following:

  • Patients with a history of malignancy and new evidence of nerve entrapment

  • Patients with back pain associated with paralysis or gross muscle weakness

  • Patients with bilateral neurologic deficits associated with bowel or bladder function loss

  • Patients on anticoagulants with sudden onset of back pain

  • Patients in whom an epidural hematoma or epidural abscess is suspected

  • Postoperative patients with a recent lumbar laminectomy or hip replacement

Improvement occurs in almost all patients within 4-6 weeks, except those with infection, occult malignancy, or systemic illness. If pain fails to significantly improve or resolve in this time frame, imaging is always indicated. [25]

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