Epidemiology Low back pain affects 50-80% of population in lifetime $100 billion in annual cost second only to respiratory infection as cause to visit doctors office Etiology Mechanism muscle strain most common cause of low back pain most common degenerative disorders lumbar spinal stenosis lumbar disc herniation discogenic back pain Risk factors obesity, smoking, gender lifting, vibration, prolonged sitting job dissatisfaction Red flags infection (IV drug user, h/o of fever and chills) tumor (h/o or cancer) trauma (h/o car accident or fall) cauda equina syndrome (bowel/bladder changes) Outcomes 90% of low back pain resolves within one year Presentation Symptoms axial pain musculogenic most common cause of back pain associated with activity characterized by stiffness and difficulty bending discogenic pain controversial confirmed by discogram mechanical pain caused by facet degeneration micro and macro instability worse with activity such as lifting objects and prolonged standing sacroiliac symptoms pain originating from sacroiliac joint peripheral / neurogenic radicular pain unilateral leg pain usually dermatomal referred pain buttocks posterior thighs inguinal region (think L5-S1) neurogenic claudication pain in buttock and legs that is worse with prolonged standing fairly specific for spinal stenosis myelopathy clumsiness in hands gait instability due to injury of spinal cord (~ L1 or above) conus medullaris syndrome cauda equina syndrome bilateral leg pain LE weakness saddle anesthesia bowel/bladder symptoms spinal cord injury incomplete complete Wadell Signs system to evaluate non-organic back pain symptoms, clinically significant if three positive signs are present superficial and non-anatomic tenderness pain with axial compression or simulated rotation of the spine negative straight-leg raise with patient distraction regional disturbances which do not follow dermatomal pattern overreaction to physical examination Imaging Radiographs indications for radiographs pain lasting > one month and not responding to not nonoperative management red flags are present MRI highly sensitive and specific high rate of abnormal findings on MRI in normal people Positive MRI Findings in Asymptomatic Patients Age % HNP % Disc Bulge % Degeneration 20-39 21 56 34 40-59 22 50 59 60-79 36 79 93 Differential Neck and arm pain trauma cervical spondylosis metastatic disease / infection cervical radiculopathy cervical myelopathy ankylosing spondylitis Thoracic back and rib pain trauma metastatic disease / infection thoracic disc herniation osteoporotic comression fracture trauma Low back pain muscles strain disc herniation / discogenic pain degenerative spondylolithesis spinal stenosis lumbar radiculopathy abdominal aortic aneurism Sacroiliac pain SI infection ankylosing spondylitis Sacral pain coccydynia sacral insufficiency fracture Treatment Treatment dictated by cause of pain.
QUESTIONS 1 of 8 1 2 3 4 5 6 7 8 Previous Next (SBQ12SP.19) A 41-year-old male presents with acute onset of low back pain that started when he was trying to lift a heavy box while helping his brother move apartments two days ago. The pain has been severe enough to cause him to miss work yesterday. He has no neurologic deficits. What are the chances he will return to work within 6 weeks? QID: 3717 Type & Select Correct Answer 1 80 to 90% 60% (2226/3721) 2 70 to 80% 16% (613/3721) 3 60 to 70% 16% (612/3721) 4 50 to 60% 4% (162/3721) 5 40 to 50% 2% (91/3721) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.119) A 35-year-old female presents for evaluation of new onset lumbar spine pain. Which of the following physical exam findings is indicative of an organic cause of low back pain symptoms? QID: 3542 Type & Select Correct Answer 1 Positive straight-leg raise with patient distraction 87% (3440/3945) 2 Pain with axial loading of the spine 3% (136/3945) 3 Diffuse tenderness with palpation of the paraspinal lumbar musculature 4% (146/3945) 4 Lower extremity numbness in a non-dermatomal pattern 4% (143/3945) 5 Pain with simulated rotation of the lumbar spine 2% (68/3945) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ10.215) A 29-year-old male reports a 2-day history of atraumatic low back pain. He denies constitutional symptoms. He denies any bowel or bladder difficulties and physical examination reveals full motor strength and sensation. No pathologic reflexes are detected. All of the following are appropriate at the initial visit EXCEPT? QID: 3308 Type & Select Correct Answer 1 Limited oral analgesia 7% (215/3159) 2 Radiographs of lumbar spine 84% (2649/3159) 3 Schedule outpatient follow-up visit within 4 weeks 4% (119/3159) 4 Early range of motion exercises 2% (70/3159) 5 Reassurance 3% (84/3159) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ07.116) A 32-year-old manual laborer has work-related chronic musculoskeletal back pain for several years. Which of the following is the strongest negative predictor for a successful clinical outcome with non-operative treatment? QID: 777 Type & Select Correct Answer 1 Race 0% (11/2889) 2 Smoking status 22% (626/2889) 3 High Visual Analog Scale (VAS) scores prior to treatment 40% (1144/2889) 4 Type of occupation 33% (961/2889) 5 Gender 5% (139/2889) L 4 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic
All Videos (1) Podcasts (1) Login to View Community Videos Login to View Community Videos California Orthopaedic Association Annual Meeting - 2018 Do Pathologic Changes on Imaging Studies Make Spines More Vulnerable to Injury? - Eugene Carragee, M.D., Stanford Spine - Low Back Pain - Introduction C 8/22/2018 58 views 3.0 (1) Spine⎪Low Back Pain - Introduction Orthobullets Team Spine - Low Back Pain - Introduction Listen Now 19:24 min 1/14/2020 482 plays 5.0 (3)
Back pain and bilateral hip pain (C2400) Saad Gaballah Spine - Low Back Pain - Introduction E 10/11/2015 1827 6 9