الفهرس 
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Abstract
Low back pain is one of the most common musculoskeletal disorder. About 80 % of people have at least one episode of LBP during their lifetime Most of LBP are mechanical triggered by some combination of overuse, muscle strain, and injury to the muscles, ligaments and discs that support the spine. Some uncommon causes are serious its account for less than 5%, such as malignancy, infection, fracture, cauda equina, spinal canal stenosis and abdominal aortic aneurysm. But their clinical impact is out of proportion to their prevalence. The fear of overlooking a serious condition influences any practitioner’s approach to back pain and is a common reason for ordering multiple imaging studies and consultations. Therefore, the time, effort, and resources invested in ruling out these disorders is considerable. One of the main goals in the evaluation of acute LBP is to identify red flags that require a more detailed work-up and imaging). Malignant bone tumors may be primary or secondary. rarely occur as a primary bone tumor (less than 1% of all malignant tumors) but more frequently result from metastasis from cancer originating elsewhere in the body. Any patient older than 50 years who presents with persistent and progressive LBP , unrelieved by rest, worse at night with significantly elevated ESR should be suspected of neoplasm in spine until prove otherwise. Ankylosing spondyolitis is a chronic, multisystem inflammatory disorder of SI joints and the axial skeleton. Patients generally present of insidious onset of inflammatory LBP due to sacroilitis. The pain worsens with rest, improves with activity and is accompanied by morning stiffness that lasts 30 min, enthesitis, anterior uveitis and other system involvements. AS diagnosed by plain x-ray used to evaluate sacroiliac joint, CT and MRI to detect early sacroilitis. Fractures of lumbar vertebrae occur either due to severe trauma or pathologic weakening of the bone. Osteoporosis is the underlying cause of many lumbar fractures, especially in postmenopausal women. Osteoporotic spinal fractures are unique in that they may occur without apparent trauma. Midline back pain is the hallmark symptom of lumbar compression fractures. The pain is axial, not radiating, aching, or stabbing in quality and may be severe and disabling in trauma. The location of the pain corresponds to the fracture site. In elderly patients with severe osteoporosis, the fracture may occurs spontaneously diagnosed by history of trauma and plain x ray to detect fracture site(Heyde et al., 2005). Spinal infection is a serious condition that can erupt into sepsis or rapidly progressive vertebral destruction .Vertebral osteomyelitis is an infection in the bone and bone marrow which is caused by variety of organisms most commonly staph with higher incidence in male and immune comprised patient. The genitourinary tract is often the most common source of the infection. patient usually complain of backache especially at night and non specific symptoms fever, chill and fatigue diagnosed by CBC show lecocytosis, elevated ESR, blood culture. MRI show early the extent and location of osteomyelitis and plain x-ray show osteomylitic changes include cortical thickening, sclerosis, and irregularity. Tuberculous vertebral osteomyilitis (Potts disease) is usually secondary to an extraspinal source of infection particularly the pulmonary and urinary tracts. The basic lesion involved in Potts disease is a combination of osteomyelitis and arthritis that usually involves more than one vertebra. Patients usually complain of back pain especially at night, fever, weight loss, anorexia and easy fatigability diagnosed by positive tuberculin test, elevated ESR > 100, elevated CRP. MRI is the criterion standard for evaluating disc-space infection and osteomyelitis of the spine and is most effective for demonstrating the extension of disease into soft tissues. Plain x-ray show Lytic destruction of anterior portion of vertebral body. Cauda equina syndrome is mechanical compression of the nerve roots it’s a rare serious cause presents by LBP, usually bilateral sciatica, saddle sensory disturbances, bladder and bowel dysfunction, and variable lower extremity motor and sensory loss. Acute onset of CES consider an emergency, require urgent MRI. Surgical decompression should be occur within 48 hours to avoid irreversible damage to the nerve roots.