Low Back Px

Question 1

What is the time frame to consider Back Px as chronic in nature?

Answer 1

Constant Px x 12 wks or more

Question 2

What are the most important systemic etiologies you should keep on your differential when a PT comes in with non-specific back pain?

Answer 2

Spinal cord compression / cauda equina syndrome
Metastatic cancer (1.2%; 9% if prev. CA)
Spinal Epidural abscess
Vertebral osteomyelitis
Discitis

Question 3

What are some warning signs of infection that you should r/o in your Hx and PE with back pain?

Answer 3

Fever
IVDA
Recent infxn
Immunosuppression
Dull, continuous ache over the spinous process

Question 4

PT presents with perineal / saddle paresthesia… You must rule out what condition right out of the gate?

What Hx and PE should you obtain further to support or negate your suspicions of this

Answer 4

Cauda Equina syndrome (compromised canal below L1)

Urinary Retention
Decreased sphincter tone
Commonly occurs from a massive Herniated nucleus pulposus

Question 5

What are some possible etiologies outside of the spine which could elicit back pain?

Answer 5

Herpes zoster
Pancreatitis 
Nephrolithiasis
AAA
Pyelonephritis

Question 6

What are some risk factors for vertebral compression factures?

Answer 6

Old age
Osteoporosis
Steroid use

Question 7

Pain that decreases with sitting or spinal flexion would lead you to suspect what condition? Claudication pain with walking or standing may also be the CC of this PT.

Answer 7

Spinal Stenosis

Constriction of the spinal canal around the cauda equina

Age >65 puts individuals at higher risk for this