Low Back Pain

Ivory Vertebra Sign

An increase opacity of vertebral body on XR that retains size and contour

What can cause Ivory Vertebrae Sign

Osteoblastic Metastases (Prostate and Breast)

Lymphoma

Hemangioma

Paget Disease of Bone

What are mechanical causes of lower back pain

Lumbar Strain

Degenerative Diseases

Congenital Disease

Osteoporosis

What degenerative diseases cause lower back pain

Discs (spondylosis)

Facet joints (osteoarthritis)

Herniated disc

Spinal stenosis

Spondylolysis

Spondylolisthesis

What congenital conditions cause lower back pain

Kyphosis

Lordosis

Scoliosis

Transitional vertebra

What are the types of causes for non-mechanical lower back pain

Neoplastic

Infectious

Inflammatory

What are the neoplastic lower back pain

Multiple myeloma

Lymphoma and leukemia

Metastatic carcinoma

Spinal cord tumors

Retroperitoneal tumors

What are the infectious lower back pain

Osteomyelitis

Septic discitis

Paraspinous abscess

Epidural abscess

What are the inflammatory lower back pain

Ankylosing spondylitis

Psoriatic spondylitis

Reactive arthritis

Paget disease

What are the causes of visceral lower back pain

Pelvic Conditions

Fat Herniation of Lumbar Space

Renal Disease

Aortic Aneurysm

Aortic Dissection

GI Disease

What pelvic conditions cause visceral back pain?

Prostatitis

Endometriosis

Premenstrual dysphoric disorder (PMDD)

Chronic PID

What renal conditions cause visceral back pain?

Nephrolithiasis

Pyelonephritis

Perinephric abscess

What GI conditions cause visceral back pain?

IBS

Pancreatitis

Cholecystitis

Penetrating ulcer

What are PMH red flags for lower back pain

Age <16 or > 50 with new onset

Prior hisotry of known metastatic cancers (Prostate / Thyroid / Breast / Lungs / Kidneys)

Trauma

Osteoporosis

Long Term Steroid Use

Serious Recent Infection

IVDA

What are PSH red flags for lower back pain

Peripheral / Central Line

Surfically implanted Cath

Prior back surgery

Recent GI or GU procedure

What are symptom red flags for lower back pain

Fever

Chills

Night Sweats

Unintentional Weight Loss

Motor or Sensory Deficit

Change in Bowel and Bladder Functio

Worring Pain

What are worrying characteristics of lower back pain

Thoracic pain

Progressively worsening

Sudden severe worsening

Worsens when supine

Worsens with rest

Wakes patient up in second half of the night

Unresponsiveness to previous therapies

Lower back pain that worsens with standing but improves with flexion indicates…

Spinal Stenosis

Lower back pain that worsens with extension can indicate

Spondylosis

Lower back pain is worse in the mornin but improves with execrise indicates

Ankylosing Spondylitis

Lower back pain that can occur in the night indicates

Metastatic Disease

Ankylosing Spondylitis

A patient comes in for lower back pain. They say the pain is diffuse across the lower back and hurts more with movement. The pain is better with rest. On exam, you notice lumbar tenderness. This is most likely

MSK Strain/Sprain

Spondylosis / Degenerative Disk disease

An eldery paitent comes in for lower back pain. He states that pain is worse with standing and walking but better with rest and when he bends forward. He also that he has leg pain that gets worse than back pain. This is likely

Spinal Stenosis

A patient comes in for back pain. The patient states that pain came on suddenly when lifting and is worse with flexion. On exam, you note tenderness over the spinous process of T8 and slight kyphosis. This is likely 

Compression Fracture

A patient comes in for leg pain. The patient states that pain is worse with cough and sitting. The patient states they also have lower back pain, but not to the same degree. On exam, you notice the patient whince in pain when asking them to raise one leg stragiht out. This is likely

Hernaited Disc

A patient comes in for back x 3 months. They say the pain is worst in the morning and get better with activity. On exam, you note reduced flexion of the back with some SIJ tenderness/ This is likely

Ankylosing Spondylitis

A patient comes in for back pain/ They say the pain wakes them up in the night and does not get better with rest. On exam, you note they have a temp of 102F and their weight is down 15 lbs from the last vistit. In additon, ROM seems limited and the vertebrae are tender. This is likely

Malignancy

A patient comes in with back pain. They state that pain is constant and hurt more when someone touches their back. On exam, you note midline tenderness and a temp of 101F. In addition, you note injection marks in their antecubits. This is likely 

Osteomyelitis

A patient comes in with back pain. They state they have been unable to hold bowel and urine as much as they would like. They also note they feel weaker than usual. On exam, you note a decrease of sensation on the legs. This is likely

Cauda Equina Syndrome

What are signs of L4 nerve compression?

Pain = Lateral Thigh and Anterior Leg

Numbness= Knee

Motor Weakness = Tight Extension

Reflex = Knee Jerk

What are signs of L5 nerve compression?

Pain = Superior Buttocks Lateral Thigh and Leg Leg

Numbness= Medial Anterior Leg

Motor Weakness = Dorsiflexion

Reflex = N/A

What are signs of S1 nerve compression?

Pain = Midline Buttocks, Posterior Thigh and Posterior Leg

Numbness= Posterior Leg

Motor Weakness = Plantar Flexion

Reflex = Ankle Jerk

How do we screen for spinal nerve compression for the leg

L4 = Squat and Rise

L5 = Heel Walk

S1 = Walk on Toes