Pain or Limitation of Back Movements with Onset Over Years

CLINICAL DIAGNOSTIC MANUAL

Pain or limitation of back movements that gradually develops over the years is a common problem that can significantly affect a person’s quality of life.

This type of pain is usually the result of degenerative changes in the spine, although it may be influenced by other systemic or mechanical factors. Identifying the underlying cause is crucial for effective management and to prevent the progression of functional deterioration.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmed Diagnosis
Osteoarthritis	Pain that worsens with activity and improves with rest, morning stiffness, limitation of movement.	Based on medical history and physical examination.	X-rays show joint space narrowing, osteophytes.
Spondylosis	Chronic pain, stiffness, limited movement, occasional radiculopathy.	Presence of chronic symptoms and physical examination.	X-rays, MRI, or CT scan showing disc degeneration and osteophytes.
Spinal Stenosis	Pain radiating to the legs, worsens with walking, improves with forward bending, weakness, or numbness.	History of radicular pain and signs of neurogenic claudication.	MRI or CT scan to visualise canal narrowing.
Spondylolisthesis	Low back or gluteal pain, radiculopathy, sensation of instability in the spine.	Mechanical pain with specific movements and possible palpable deformity.	X-rays to see vertebral displacement, confirmed with MRI or CT scan.
Compression Fractures	Acute, localised pain, loss of height, visible spinal deformity in severe cases.	History of minor trauma or osteoporosis, localised pain on palpation.	X-rays, CT scan, or MRI showing fracture and vertebral deformity.
Degenerative Scoliosis	Chronic pain, visible spinal deviation, stiffness, muscle fatigue.	Visual inspection and palpation of abnormal curvature.	Full spine X-rays to measure angle and curvature.
Disc Herniation	Radicular pain, weakness, altered sensation, abnormal reflexes, positive Lasegue sign.	Based on pain location and neurological symptoms.	MRI to identify disc protrusion or herniation.
Inflammatory Disease	Pain and stiffness that improves with exercise but not with rest, good response to NSAIDs, possible gradual onset.	History and physical examination suggest inflammatory pattern of pain.	Imaging tests such as MRI, and blood tests for inflammatory markers.
Spinal Tumours	Persistent, nocturnal, and intractable pain, weight loss, possible weakness or paralysis.	Persistent and progressive symptoms without a clear apparent cause.	MRI or CT scan to identify mass, confirmed with biopsy.