Low Back Pain

Posted by e-Medical PPT Saturday, September 15, 2012
Epidemiology
50-60% Life time incidence of LBP
15-30% prevalence among adults
1% of population are disabled because of LBP
15% of the sick leave
85% no specific diagnosis can be made
Highest prevalence 40-60 year of age
Overall incidence of LBP 45/1000 person per year

Clinical presentation
LBP +/- radiculopathy
Pain exacerbated with physical stress and relieved with bed rest
P/E differentiate mechanical (non-specific) LBP from serious spinal conditions (radiculopathy or cauda equina syndrome caused by PID, tumors, infections…..)

History / red flags
Hx of cancer (prostate, breast, kidney, thyroid, lung)
Unexplained wt loss
Immunosuppression
Pain that worse at rest
psuedoclaudication
Pain not responding to conservative Rx
Skin or other systemic infection
Urine and fecal incontinence

Disc Herniation
L4-5, L5-S1 most common
Cervical and thoracic do occur
Thoracic: abrupt neuro deficits
Postero-lateral aspect of the disc
Not necessary to have history of strain or injury
Unilateral radicular back pain with nerve root impingement
X-ray only good if inter-vertebral disc is narrow
MRI is gold standard
Electromyelography localizes the specific nerve root

Absolute indication for surgery
Significant muscle weakness
Progressive neurological deficit with bed rest
Bowel or bladder dysfunction

Relative indication for surgery
Pain despite bed rest
Recurrent episodes of severe pain

Discectomy/Complications
Infection (superficial vs deep)
Increased deficit (injury to neural structure)
Dural tear (CSF leak)
Complications of positioning
Failed surgery (incorrect dx, incomplete surgery)
Vascular injury
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