Low Back Pain

Question 1

Red flags for lower back pain

Answer 1

age < 20 years or > 50 years
history of previous malignancy
night pain
history of trauma
systemically unwell e.g. weight loss, fever

Question 2

DDx of lower back pain?

Answer 2

Cauda Equina

Ankylosing Spondylitis

Peripheral Artery Disease

Spinal Stenosis

Question 3

Usually gradual onset

Unilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking. Resolves when sits down. Pain may be described as ‘aching’, ‘crawling’.
Relieved by sitting down, leaning forwards and crouching down
Clinical examination is often normal

Requires MRI to confirm diagnosis

Answer 3

Spinal Stenosis

Question 4

Typically a young man who presents with lower back pain and stiffness

Stiffness is usually worse in morning and improves with activity

Peripheral arthritis (25%, more common if female)

Answer 4

Ankylosing Spondylitis

Question 5

Pain on walking, relieved by rest
Absent or weak foot pulses and other signs of limb ischaemia
Past history may include smoking and other vascular diseases

Answer 5

Peripheral Artery Disease