History (spine)

When taking a history from a patient with spinal problems, the following areas should be broached:

• pain:
  • onset, site, radiation
  • does the pain radiate to the leg as in sciatica
  • aggravating and relieving factors e.g. posture, or if neurogenic claudication appears to be the problem, is cycling easier?
  • persistent pain which occurs throughout the night should alert one to the possibility of a tumour
    
    
• stiffness:
  • sudden and complete in disc prolapse, or continuous and worse in the morning with arthritis or ankylosing spondylitis
    
    
• deformity:
  • onset, changes, general history, neurological features, pain
    
    
• neurological symptoms:
  • numbness, paraesthesia; onset, progress, degree
  • spinal claudication ?

It is also important to ask specifically about weight loss, bowel, pulmonary and bladder dysfunction.