Evaluation of Back Pain in PC (final) Flashcards
>___% of pts who present to PC have LBP that cannot be attributed to a specific dz or spinal pathology.
>85% of pts who present to PC have LBP that cannot be attributed to a specific dz or spinal pathology.
A pt presents to PC with LBP. Which conditions must be ruled out?
Hint: there are 7 and they are all rare.
- Ankylosing spondylitis (0.3% to 5%)
- Compression fx (4%)
- Symptomatic herniated disc (4%)
- Spinal stenosis (3%)
- Cancer (0.7%)
- Cauda equina syndrome (0.04%)
- Spinal infection (0.01%)
*The last 2 are why we get sued
T/F: There have been upward trends in utilization of imaging studies, incidence of surgery, use of injections, Rx opioids, and costs, which have all been absolutely fantastic for decreasing disability due to LBP!
Nope. None of that sh*t is working.
What are the goals for PC providers with LBP?
- Prevention of disability is the primary goal!
- Find the small (small!) percentage of pts who have an emergent cause of back pain
Acute back pain is how many weeks?
<4 wks
Subacute back pain is how many weeks?
4-12 wks
Chronic back pain is how many weeks?
>12 wks
What percentage of back pain pts will progress into chronic back pain?
Approx 20%
Name some risk factors for developing chronic LBP
- Physiologic factors are the strongest predictors
- Congenital spine abnormalities
- Smoking
- Occupation
- Prior episode of LBP
- Physical unfitness
- Increasing age
What are the red flags of back pain?
*Jaynstein emphasized this slide*
- Trauma
- Unexplained wt loss
- Neurologic sx
- Age >50
- Fever
- IVDU
- Steroid use
- Hx of cancer
LBP stinks more than tunafish
We’re usually pretty good at asking about loss of bowel/bladder, but this is usually a late finding of cord injury. What is an early sign of cord injury that we should also be asking about?
Urinary retention
Cancer accounts for ___% of pts who present to PC for eval of LBP
<1%
A pt with PMH of cancer presents with LBP is ____________ until proven otherwise
Metastatic disease
Most common primary cancers to metastasize to spine/bone include….
Breast, lung, prostate
Pt presents with night time pain in back. You should immediately think of _______ and your workup should include ____________________________.
Pt presents with night time pain in back. You should immediately think of cancer and your workup should include CBC, plain films, direct to possible source.
Fever + back pain = ___________ until proven otherwise
Spinal abscess
40% of spinal infections come from ____________, _____________, ____________, and ____________.
- Urinary infection
- Indwelling catheter
- Skin infection
- IVDU
T/F: Fever is sensitive for diagnosing spinal infections
False. Only 40% overall:
- 83% in epidural abscess
- 50% in pyogenic osteomyelitis
- 27% in TB osteomyelitis
T/F: Spinal TTP is sensitive for spinal infection
True. Spinal TTP is 86% sensitive and 60% specific.
In the workup of a potential spinal infection, which lab is the most sensitive and specific?
ESR
What kind of imaging is the TOC for spinal infection?
MRI w/ and w/o contract
___% of compression fractures will be atraumatic
30%
A 70 y/o F on long-term corticosteroid therapy comes in with back pain. She has midline TTP directly over T7. Her T-spine XR is negative for fx. What might you consider next in your workup to confirm or r/o a compression fx?
CT w/o
A kyphoplasty is indicated in someone with a compression fx with loss of ___% of vertebral high?
>50%
