Low Back Pain

Question 1

What is the most common cause of disability for patients under the age of 45 and is the 2nd most common cause for primary cause visits?

Answer 1

low back pain

Question 2

The annual prevalence of LBP is __-__%

Answer 2

15-45%

Question 3

Approximately __% episodes of LBP resolve within 3 weeks and __% resolve within 6 weeks

Answer 3

80

90

Question 4

What are the alarming symptoms for LBP caused by cancer?

Answer 4

• unexplained weight loss
• failure to improve with treatment
• pain for more than 6 weeks
• pain at night or during rest

Question 5

What are 2 other risk factors for malignancy?

Answer 5

History of cancer and age greater than 50

Question 6

What are the alarming symptoms for LBP caused by infection?

Answer 6

• fever
• rest pain
• recent infection (UTI, cellulitis, pneumonia)
• history of immunocompromise or injection use

Question 7

What suggests LBP caused by cauda equina syndrome?

Answer 7

• urinary retention or incontinence
• saddle anesthesia
• decreased anal sphincter tone or fecal incontinence
• bilateral LE weakness
• progressive neurological deficits

Question 8

What suggests LBP caused by fracture?

Answer 8

• corticosteroid use
• age greater than 70
• history of osteoporosis
• recent significant fracture
• very severe focal pain

Question 9

LBP may also be the presenting symptom is what other serious medical problems?

Answer 9

• abdominal aortic aneurisms
• peptic ulcer disease
• kidney stones
• pancreatitis

Question 10

A positive one-leg standing extension test may indicate what?

Answer 10

• pars interarticularis fractures (spondylosis or spondylolisthesis)
• facet joint arthritis

Question 11

What 4 symptoms suggest nonorthopedic causes for LBP or malingering?

Answer 11

• superficial skin tenderness to light tough of the lumbar spine
• overreaction to maneuvers in the regular back examination
• LBP on axial loading of spine in standing
• inconsistency in the SLR test or on the neuro exam

Question 12

In the absence of red flag symptoms suggesting infection, malignancy, or cauda equnia syndrome diagnostic imaging is not typically recommended for the first _ weeks

Answer 12

6

Question 13

What special tests may be performed in assessing patients with possible nerve root symptoms lasting longer than 6 weeks?

Answer 13

electromyography or nerve conduction studies

Question 14

What things can be done to conservatively treat LBP?

Answer 14

• proper lightning technique instruction
• core strengthening
• weight loss
• smoking cessation

Question 15

True or False

NSAIDs are effective in the early treatment of LBP

Answer 15

True

Question 16

What are the surgical indications for back surgery?

Answer 16

• cauda equina syndrome
• ongoing morbidity with no response to conservative treatment for over 6 months
• cancer
• infection
• severe spinal deformity

Question 17

When is surgical prognosis improved?

Answer 17

When there is an anatomic lesion that can be corrected and symptoms are neurologic

Question 18

What are some possible surgical complications?

Answer 18

• persistent pain
• surgical site pain
• infection
• neurologic damage
• non-union
• cutaneous nerve damage
• implant failure
• DVT
• death

Question 19

When should you refer a patient with LBP?

Answer 19

• patients with cauda equina syndrome
• patients with cancer, infection, or severe spinal deformity
• patients who have not responded to conservative treatment