acute low back pain

Question 1

red flag symptoms in low back pain

Answer 1

unrelenting night pain
unrelenting pain at rest
neuromotor deficit
unexplained fever
greater than 6 wks 
age over 70
loss of bowel or bladder control
progressive focal neurologic ddeficits
suspicion of ankylosing spondylitis
trauma
hx or suspicion of cancer
osteoporosis
chronic corticosteroid use
immunosuppression
alcohol abuse
IV drug use

Question 2

differential diagnosis for low back pain

Answer 2

mechanical (97%):

• lumbar strain, sprain (70%)
• degenerative facets or disks (10%)
• herniated disk
• compression fracture
• spinal stenosis
• spondylolistehsis
• spondylolysis

nonmechanical:

• cancer
• inflammatory arthritis
• infection

visceral dis:

• pelvic organs: prostatitis, PID, endometriosis
• renal dis: nephrolithiasis, pyelonephritis, perinephric abscess
• aortic aneurysm
• GI dis: pancreatitis, cholecystitis, peptic ulcer

Question 3

symptoms of cauda equina syndrome

Answer 3

increasing neuro deficits, leg weakness
bowel and urinary incontinence
anesthesia/paresthesia in saddle distrib
bilateral sciatica

PE:
reduction in anal sphincter tone
decreased ankle reflexes

Question 4

MRI is not recommended for pts with sciatica unless

Answer 4

symptoms last more than 1 month

or if pt is not a candidate for surgery or epidural injection

Question 5

spinal stenosis symptoms

Answer 5

low back pain, leg pain
leg weakness
pseudoclaudication

Question 6

how can spinal stenosis pain be relieved?

Answer 6

bending over
squatting
lying
sitting

Question 7

tx for spinal stenosis

Answer 7

NSAIDs
PT
epidural corticosteroids
surgical therapy if others fail or progressive neuro defic

Question 8

vertebral compression fractures more common in

Answer 8

elderly
osteoporosis
chronic steroid use

Question 9

symptoms of vertebral compression fx

Answer 9

acute onset back pain after certain sudden movements like lifting, bending, coughing

pain follows distribution of contiguous nerve and radiates bilaterally into anterior abdomen

generally well localized to T12-L2 of spine

Question 10

tx of acute mechanical back pain (less than 4 wks)

Answer 10

NSAIDs
acetaminophen
muscle relaxants
heat
early mobility

Question 11

tx of vertebral compression fractures

Answer 11

pain control
PT
calcitonin, bisphosphonates, tx underlying osteoporosis

balloon kyphoplasty maybe considered in severe pain