My daily and sometimes hourly puzzle is whether a certain complaint is of mechanical or toxic origin. Is this particular back or knee or foot trouble caused by some congenital deformity or some traumatic injury or by some postural strain or is it some sort of an arthritis, or myositis or neuritis caused by poisons absorbed from some focus of infection elsewhere in the body?
In considering disabling back pain there are other possibilities which must first be cleared up. One must be sure there is no gross lesion, such as a compression fracture of a vertebra or a fracture of the transverse or spinous processes. Good roentgenograms, both anteroposterior and lateral, will settle that. One must also be sure that there is not some destructive bone disease, such as tuberculosis or cancer. Here again, the roentgenogram usually gives definite information. When there is doubt as to the interpretation, the
SCHAUFFLER RM. DISABLING BACK PAINDIFFERENTIAL DIAGNOSIS AND TREATMENT. JAMA. 1930;95(23):1717–1721. doi:10.1001/jama.1930.02720230011003