Low Back Pain Flashcards
define non-specific low back pain
pain not due to any specific or underlying disease that can be found
define mechanical low back pain
pain after abnormal stress and strain on the vertebral column
define nerve root pain (sciatica)
pain radiating to the lower limbs with or without neuralgic symptoms
causes of low back pain
mechanical: disc herniation/degeneration, annular tears, facet joint OA
tumour, infection, spondyloarthropathy
pars interarticularis injury, compression fracture, visceral
indicators for sciatica from history or physical examination
unilateral leg pain greater than lower back pain
pain radiating to foot or toes
numbness/paraesthesia in same distribution
straight leg raising test induces more leg pain
localised neurology
conservative treatment for sciatica
analgesia
anti-inflammatory drugs
manipulation
acupunture
massage
allow time to pass ( most get better spontaneously)
bed rest doesn’t result it faster recovery
red flags for low back pain
weight loss
fever
night pain
under 19 years of age
red flags for leg pain
bowel or bladder dysfunction
saddle anaesthesia
profound neurological deficit
for what conditions is waiting too long to diagnose very dangerous?
metastases
inflammatory arthropathy
myeloma
tuberculosis of the spine
why can early diagnosis be so important?
sometimes essential for effective treatment
risk of disease progression e.g. fractures, paralysis
primary imaging investigation for low back pain
MRI
secondary imaging investigation for low back pain
radiographs
CT
pros and cons to radiographs
pro: cheap, readily available, traditional
con: radiation, overlooks most important diseases
what important diseases could be missed on a radiograph?
pagets sarcoma anorexia nervosa adolescent disc prolapse lesions osteoid osteoma
what type of diseases will show up on limited MRI?
80% degeneration
20% other e.g infection, tumour, pars defects, spondyloarthropathy, insufficiency fracture, aortic aneurysm