FM - Neck and Back Pain

Question 1

List 5 common causes for low back pain.

Answer 1

1. Muscle spasm/ligamentous strain
2. Trauma
3. Osteoarthritis (degenerative disc disease, facet joint disruption/degeneration, herniated disc, spinal stenosis)
4. Osteoporosis -> vertebral compression fracture
5. Vertebral metastases

Question 2

When will you consider imaging studies to investigate back pain?

Answer 2

Consider imaging when there is:

• Pain lasting >1 month
• Very severe pain
• Numbness
• Muscle weakness
• Accidents that might involve the vertebrae
• Fever
• History of cancer
• Radiating pain to lower extremity

Question 3

List the 4 available imaging procedures for low back pain.

Answer 3

1. Plain radiographs
2. MRI
3. CT
4. Bone scan

Question 4

What is the utility of plain radiographs in the setting of low back pain?

Answer 4

Can r/o tumors, infection, and injury; can show signs of stenosis and changes 2/2 aging

Question 5

What is the utility of MRI in the setting of low back pain?

Answer 5

More accurate, allows for visualization of soft tissue and bone; can detect annular tears, infection, and cancer

Question 6

What are some limitations to MRI in the setting of low back pain?

Answer 6

• Misses 6-23% of damaged discs found during surgery
• About 40% of adults are found to have “bulging discs,” however the majority do not have back pain
• Thus, back pain and disc problems revealed through imaging are not necessarily always correlative

Question 7

What is the utility of CT scan in the setting of low back pain?

Answer 7

-Focal fractures of vertebral foraminal stenosis

Question 8

What is the utility of bone scans in the setting of low back pain?

Answer 8

-Useful for spinal fracture, cancer, and OA