From the Guidelines
Lumbar spine tenderness is most commonly caused by nonspecific low back pain, which cannot be reliably attributed to a specific disease or spinal abnormality.
Etiology of Lumbar Spine Tenderness
- The etiology of lumbar spine tenderness can be broadly categorized into three groups: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, and back pain potentially associated with another specific spinal cause 1.
- Nonspecific low back pain accounts for more than 85% of patients who present to primary care, and attempts to identify specific anatomical sources of low back pain in such patients have not been validated in rigorous studies 1.
- Specific causes of lumbar spine tenderness include cancer (approximately 0.7% of cases), compression fracture (4%), spinal infection (0.01%), ankylosing spondylitis (0.3-5%), spinal stenosis (3%), symptomatic herniated disc (4%), and cauda equina syndrome (0.04%) 1.
- In patients with a history of prior lumbar surgery, lumbar spine tenderness can be caused by free disc or bone fragments, postoperative scarring, failure of bone graft for fusion, and recurrent disc protrusion 1.
- Imaging studies such as MRI, CT, and CT myelography can be useful in diagnosing the cause of lumbar spine tenderness, especially in patients with new or progressing symptoms and previous lumbar surgery 1.
- A focused history and physical examination can help determine the likelihood of specific underlying conditions and measure the presence and level of neurologic involvement 1.
From the Research
Etiology of Lumbar Spine Tenderness
The etiology of lumbar spine tenderness is complex and multifaceted. Some possible causes include:
- Myofascial pain, facet joint pain, sacroiliac joint pain, discogenic pain, spinal stenosis, and failed back surgery, as noted in 2
- Degenerative origin, which is the most frequent cause, dominated by disc degeneration, as stated in 3
- Inflammatory low back pain, which can be associated with extra-spinal symptoms, as mentioned in 3
- Tumors, with metastasis being the most frequent cause, as noted in 3
- Infectious diseases, which can be of hematogenous origin or by direct iatrogenic inoculation, as stated in 3
- Clinical spinal instability, which is an important cause of low back pain, as discussed in 4
- Lumbar spinal stenosis, which is a frequent cause of low back pain among adults, caused by a narrowing impinging on the spinal cord or nerve roots, as noted in 5
Possible Mechanisms
The precise mechanism of lumbar spine tenderness is not clear, due to a lack of knowledge of the neuroanatomy of the anterior part of the spine, as stated in 6. However, some possible mechanisms include:
- Alteration of the mechanical properties of the disc, leading to degenerative arthritis in the intervertebral joints, as mentioned in 3
- Loss of normal pattern of spinal motion, causing pain and/or neurologic dysfunction, as discussed in 4
- Decrease in the neutral zone, which may be responsible for pain reduction, as noted in 4