Prevalence of serious spinal pathologies and nonspinal conditions in low back pain: a systematic review and meta-analysis.

OBJECTIVE

To estimate the prevalence of serious spinal pathologies and nonspinal conditions in people seeking care for low back pain.

METHODS

Literature searches were conducted in 6 electronic databases. Observational studies investigating the prevalence of serious spinal pathologies and nonspinal conditions in adults seeking health care for a complaint of low back pain were considered eligible. Risk of bias was assessed with a tool for prevalence studies. Meta-analyses using random effect models were conducted to obtain pooled prevalence estimates.

RESULTS

Eleven studies were included in this review; most (64%) were at low risk of bias. With moderate certainty of evidence, the pooled prevalence of serious spinal pathologies was 2.9% (95% confidence interval: 1.6% to 5.2%) in people with a complaint of low back pain at presentation. The prevalence, however, varied by setting: primary care, 0.8%; emergency department, 2.1%; secondary care, 4.6%; and tertiary care, 6.9%. With moderate certainty of evidence, the prevalence of individual serious spinal pathologies ranged from 0.3% for cauda equina syndrome to 2.4% for spinal fracture. The prevalence of nonspinal conditions from Australian emergency department studies varied greatly, ranging from 21.5% to 58.3%.

CONCLUSION

The prevalence of serious spinal pathologies and nonspinal conditions varied greatly. Differential diagnostic strategies with clear care pathways need to be available to ensure a prompt diagnosis of serious spinal pathologies and nonspinal conditions.

STUDY REGISTRATION: PROSPERO CRD42022352568.