Back Pain

cauda equina

Most related to tumors within vertebral bones

Can also be related to epidural abscess, hematoma, less commonly disc herniation

Constitutional symptoms (relationship with cancer)

Loss of bowel or bladder controk

Sensory findings (saddle paresthesia) and weakness (primary motor finding) almost always present at time of diagnosis

metastatic cancer

most common type of bone tumor

involvement of periosteum leads to pain

neurologic deficits, night pain, pain unrelieved or worsened by laying down or bed rest

insidious increase in pain

epidural abscess

fever, malaise that preceded pain

radicular pain, can progress to neurological deficits

hx of recent spinal injection, epidural catheter placement IVDU or infection

verteberal compression fracture

acute pain, point tender in center of spine

usually recent trauma like severe flexion/compression force

• elderly w/ osteoporosis

• cancer w/ lytic lesions

• long term corticosteroids use

pain usually mid-thoracic region

ankylosing spondylitis

characterized by low back pain of at least 3 months, improvement with exercise, no relief from rest, limited ROM, limited chest expansion, bilateral sacroiliitis or severe unilateral dx

onset gradual

morning stiffness

night pain

spinal stenosis

chronic low back pain, usually >60

worse with standing, walking, pain often in calf or distal lower extremity

better with forward flexion and rest

usually pain in low back, buttock, LE

may have numbness/weakness

ROM in tact

musculoligamentous strain

result in local inflammation, swelling, spasm and tenderness at location of injury

mechanism of injury usually bending, twisting or lifting

can happen in all regions of spine

pain does not always radiate but can go to low back, buttock or upper posterior thigh, SPARES lower leg

lumbar disc disease

most common in lumbosacral level

localized pain worse with bending, non-radicular pain, worse with long periods of sitting

most common presentation is sharp or burning pain down posterior lateral leg to ankle or food

weakness, hyporeflexia, hypoesthesia

pain worse with cough, valsalva or sneeze

spondylolysis ± spondylolisthesis

defect in pars interarticularis can be unilateral or bilateral

often in young athletes

lumbar pain worse w/ extension

diagnosis made by xray

high suspicion for cauda equina syndrome, malignancy, fracture or infection

no improvement after 6 weeks of conservative medical and physical therapies

imaging for lower back pain is appropriate when?

no

Is radiculopathy w/ low back pain indication for early imaging?

ice/heat

activity as tolerated

topical analgesics

tylenol/NSAIDs

muscle relaxants

Management of saroiliac joint dysfunction?