European Spine Journal

, Volume 16, Issue 10, pp 1673–1679

Screening for malignancy in low back pain patients: a systematic review

  • Nicholas Henschke
  • Christopher G. Maher
  • Kathryn M. Refshauge
Original Article

DOI: 10.1007/s00586-007-0412-0

Cite this article as:
Henschke, N., Maher, C.G. & Refshauge, K.M. Eur Spine J (2007) 16: 1673. doi:10.1007/s00586-007-0412-0

Abstract

To describe the accuracy of clinical features and tests used to screen for malignancy in patients with low back pain. A systematic review was performed on all available records on MEDLINE, EMBASE, and CINAHL electronic databases. Studies were considered eligible if they investigated a cohort of low back pain patients, used an appropriate reference standard, and reported sufficient data on the diagnostic accuracy of tests. Two authors independently assessed methodological quality and extracted data to calculate positive (LR+) and negative (LR−) likelihood ratios. Six studies evaluating 22 different clinical features and tests were identified. The prevalence of malignancy ranged from 0.1 to 3.5%. A previous history of cancer (LR+ = 23.7), elevated ESR (LR+ = 18.0), reduced hematocrit (LR+ = 18.2), and overall clinician judgement (LR+ = 12.1) increased the probability of malignancy when present. A combination of age ≥50 years, a previous history of cancer, unexplained weight loss, and failure to improve after 1 month had a reported sensitivity of 100%. Overall, there was poor reporting of methodological quality items, and very few studies were performed in community primary care settings. Malignancy is rare as a cause of low back pain. The most useful features and tests are a previous history of cancer, elevated ESR, reduced hematocrit, and clinician judgement.

Keywords

Low back painDiagnosisMalignancyRed flags

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Nicholas Henschke
    • 1
  • Christopher G. Maher
    • 1
  • Kathryn M. Refshauge
    • 1
  1. 1.Back Pain Research Group, School of PhysiotherapyUniversity of SydneyLidcombeAustralia