Low Back Pain

Question 1

What is the time frame for acute back pain? Subacute? Chronic?

Answer 1

Acute: less than 4 weeks
Subacute: Lasts 4-12 weeks
Chronic: more than 12 weeks

Question 2

What is the most common cause of spinal cord or cauda equina compression?

Answer 2

herniation of intervertebral disc

Question 3

What are early symptoms of spinal cord/cauda equina compression? what are the late symptoms?

Answer 3

early: pain, weakness and parasthesias
late: bowel or bladder dysfunction

Question 4

What is a spinal epidural abscess?

What are the symptoms?

Answer 4

accumulation of pus in the epidural space that can mechanically compress the spinal cord

fever, malaise, then more localized pain, radicular pain and if left untreated neurologic defects

Question 5

What is vertebral osteomyelitis?

Answer 5

infection of the vertebrae. presents with back pain

Question 6

L4 compromise would manifest as what?

Answer 6

motor weakness in extension of quadriceps, patellar reflex diminished, can’t squat and rise. numbness over knee

Question 7

L5 compromise would manifest as what?

Answer 7

motor weakness of dorsiflexion of the great toe and foot. can’t heel walk. numbness in side of leg and thigh

Question 8

S1 compromise would manifest as what?

Answer 8

motor weakness of plantar flexion of great toe and foot. can’t walk on toes. achilles reflex diminished

Question 9

What is the imaging modality recommended for acute back pain?

Answer 9

none

Question 10

What imaging is recommended for patients with symptoms of spinal cord or cauda equina compression or severe neurologic deficits?

Answer 10

MRI

Question 11

What are the red flags that would indicate vertebral fracture and to get imaging done?

Answer 11

older age, prolonged use of corticosteroids, severe trauma and presence of contusion or abrasion?