Introduction 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 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 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK 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? Review Topic QID: 3542 1 Positive straight-leg raise with patient distraction 88% (2836/3223) 2 Pain with axial loading of the spine 3% (101/3223) 3 Diffuse tenderness with palpation of the paraspinal lumbar musculature 3% (97/3223) 4 Lower extremity numbness in a non-dermatomal pattern 4% (124/3223) 5 Pain with simulated rotation of the lumbar spine 2% (54/3223) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 1 (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? Review Topic QID: 3308 1 Limited oral analgesia 7% (172/2542) 2 Radiographs of lumbar spine 84% (2134/2542) 3 Schedule outpatient follow-up visit within 4 weeks 4% (98/2542) 4 Early range of motion exercises 2% (55/2542) 5 Reassurance 3% (68/2542) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 2 (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? Review Topic QID: 777 1 Race 0% (8/2309) 2 Smoking status 21% (474/2309) 3 High Visual Analog Scale (VAS) scores prior to treatment 41% (942/2309) 4 Type of occupation 33% (758/2309) 5 Gender 5% (124/2309) ML 4 Select Answer to see Preferred Response PREFERRED RESPONSE 3
Back pain and bilateral hip pain (C2400) Spine - Low Back Pain - Introduction HPI - Condition started back in 2005 with lower back pain which was treated conservatively and slightly improved. In 2009 the patient had progressive left hip pain. In 2012 pt was diagnosed to have stress fracture of left femoral neck and had percutaneous fixation of the neck. The patient had slight improvment of symptoms for a short period of time. Now the patient continues ot have bilateral hip pain and low back pain. Current radiographs show an incomplete fracture of the right femoral neck and L5 pars defect. Lab studies have been normal. What do you think is the most likely cause of the patients current symptoms? 10/11/2015 1531 3 9