The incidence, providers involved, and patient factors associated with diagnosis of specific lumbar spine pathology subsequent an initial nonspecific low back pain diagnosis

• Published in: The spine journal 2024-11
• Main Authors: Seddio, Anthony E., Jabbouri, Sahir S., Gouzoulis, Michael J., Sanchez, Joshua G., Day, Wesley, Varthi, Arya G., Rubio, Daniel R., Grauer, Jonathan N.
• Format: Article
• Language: English
• Subjects: Epidemiology; LBP; Low back pain; Lumbar spine pathology; Multidisciplinary management; Nonspecific low back pain; Subsequent diagnosis
• ISSN: 1529-9430; 1878-1632; 1878-1632
• DOI: 10.1016/j.spinee.2024.10.008

•Primary care providers diagnose the majority of nonspecific LBP.•Patients initially diagnosed are rarely later identified with underlying pathology.•Various factors were found to contribute to diagnostic difficulty for some patients.•Diagnoses of specific lumbar pathology are often made expeditiously within 3-months. Low back pain (LBP) is an exceedingly common diagnosis with significant societal and healthcare burden. While nonspecific LBP diagnoses are frequently assigned and often resolve soon thereafter, some patients may subsequently be diagnosed with specific underlying lumbar spine pathology. To characterize the incidence, providers involved, and factors associated with specific pathology LBP (SP-LBP) diagnosed subsequent an initial nonspecific LBP (NS-LBP) diagnosis. Retrospective cohort study. Adult patients diagnosed with NS-LBP between 2010 and Q1 2022 were abstracted from a large national administrative database. Incidence of subsequent SP-LBP diagnoses, providers involved, and factors associated with SP-LBP diagnoses in the 12-months following initial NS-LBP diagnosis. Adult patients diagnosed with NS-LBP were identified based on International Classification of Disease (ICD) codes ICD-9-D-724.2 and ICD-10-D-M54.5. These patients diagnosed with new NS-LBP were reported based on incidence per 100,000 covered lives. Exclusion criteria included: patients less than 18 years old, those with any prior NS-LBP diagnosis, any prior SP-LBP diagnoses, and those with trauma, neoplasm, or infection diagnosed within 3-months prior to the initial NS-LBP diagnosis. Patients who subsequently received SP-LBP diagnoses within 12-months following initial NS-LBP were then identified. Patients were characterized based on age, sex, history of cancer, obesity, opioid use disorder, anxiety, and depression and then compared with patients receiving no additional LBP diagnosis by univariable and multivariable analysis. Provider specialties who initially diagnosed NS-LBP and those involved with subsequent SP-LBP diagnoses were identified. NS-LBP was identified for a robust cohort of 6,861,235 patients, yielding an incidence of 4,258 diagnoses per 100,000 covered lives. Subsequent SP-LBP diagnoses were identified for 562,982 (8.21%) within 12-months, of which 62.57% of these SP-LBP diagnoses occurred within 3-months. The most common of these subsequent diagnoses included radiculopathy (3.01% of the overall study population), disc degeneration (2.84%), and disc herniation (