Back pain onset within days to months

CLINICAL DIAGNOSTIC MANUAL

Back pain with gradual onset, developing over days or months, may be related to various pathologies affecting the spine, surrounding tissues, or distant structures. Common causes include degenerative conditions such as spinal canal stenosis, spinal tumours, and infections, including tuberculosis-related ones. This type of pain can range from mild and constant to severe, limiting mobility and the patient’s quality of life. A detailed diagnostic approach is essential to correctly identify the underlying cause and guide appropriate treatment.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Lumbar spinal canal stenosis	Low back pain worsened by walking or standing, relief when sitting or bending forward, leg weakness.	Chronic low back pain with neurogenic claudication, improvement in sitting position.	MRI or CT scan showing narrowing of the spinal canal.
Spinal tumours	Persistent low back pain that does not improve with rest, weight loss, progressive weakness, neurological symptoms.	Persistent nocturnal low back pain with systemic signs (weight loss, fatigue).	MRI showing spinal mass. Tumour biopsy to confirm malignancy.
Intervertebral disc infection	Constant low back pain, fever, general malaise, localised spinal tenderness, increased pain with movement.	Low back pain with fever and history of recent infection or immunosuppression.	MRI showing signs of spondylodiscitis. Positive culture from disc biopsy or blood culture.
Spinal tuberculosis (Pott’s disease)	Progressive low back pain, fever, weight loss, night sweats, spinal deformity, possible neurological symptoms.	Chronic low back pain with systemic signs and history of tuberculosis exposure.	MRI showing vertebral lesions and abscesses. Positive tuberculosis test and biopsy confirming Mycobacterium tuberculosis.