In the evaluation of back syndromes, the examiner's goal is to discriminate between pain of neurogenic origin and pain of musculoskeletal origin, as well as to rule out nonspinal pathology. Although the potential for surgical intervention is by far greater with neurologic than with musculoskeletal involvement, in both instances surgery is indicated in less than 1 percent of all cases. If no red flags are identified that would require diagnostic imaging or immediate consultation, symptomatic treatment may be initiated. Fortunately, the majority of all lumbosacral syndromes respond to routine symptomatic treatment, including relative rest, progressive activity, simple comfort measures such as superficial heat, and oral analgesics.19
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