It is important to know of any history of similar pain and how it was treated. Aggravating and relieving factors should be ascertained. Associated numbness or weakness should be identified and any history of incontinence of bowel or bladder should be noted. Sphincter dysfunction resulting from neurologic compression constitutes a surgical emergency and is a critical part of the initial history. The physician should assess the impact of the symptoms on the patient's function at work, home, and leisure.
Medical history is important in determining the cause and planning treatment.
Diseases such as diabetes mellitus, coronary artery disease, and cerebrovascular disease may increase risk of surgical management. Comorbid medical conditions, in particular coronary artery disease and diabetes, have been found to adversely affect outcome of lumbar surgery. 7 Previous history of malignant disease helps identify patients with potential metastatic tumor. Patients using steroids for rheumatoid arthritis, transplantation, and other conditions may have significant osteopenia. Other rheumatologic disorders such as ankylosing spondylitis should also be identified.