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 non-spinal conditions in people seeking care for LBP. METHODS: Literature searches were conducted in six electronic databases. Observational studies investigating the prevalence of serious spinal pathologies and non-spinal conditions in adults seeking healthcare for a complaint of LBP were considered eligible. Risk of bias was assessed using 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%) at low risk of bias. Based on 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 LBP at presentation. The prevalence however varied by setting: Primary care 0.8%, ED 2.1%, secondary care 4.6% and tertiary care 6.9%. Based on 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 non-spinal conditions from Australian ED studies varied greatly ranging from 21.5% to 58.3%. CONCLUSION: The prevalence of serious spinal pathologies and non-spinal conditions varied greatly. Differential diagnostic strategies with clear care pathways need to be available to ensure a prompt diagnosis of serious spinal pathologies and non-spinal conditions.