Low back pain in the elderly: practical management concerns.

Low back pain occurs in 90% of the adult population. Previous episodes of low back pain in young adults predisposes to exacerbations and chronic problems in the elderly. Radiographic abnormalities demonstrating osteoarthrosis of the lumbar spine and facet joints and varying degrees of disk bulge and disk degeneration are the rule in both asymptomatic and symptomatic patients. Therefore, clinical assessments rather than purely morphological assessments are necessary to assess treatment plans and prognosis in elderly low back pain patients. Osteoarthritic changes are more often asymptomatic than symptomatic. CT and MRI demonstrations of spinal stenosis should be correlated with clinical findings to determine appropriate management decisions. Most elderly patients with low back pain with or without sciatica and with only radiographic CT or MRI rather than clinical evidence of spinal stenosis can be successfully managed conservatively.