back pain

Question 1

classificaitions of back pain

Answer 1

Acc to duration
Acute at least less than 4weeks
Subacute 4-12weeks
Chronic >12 weeks

Question 2

Differentials of back pain

Answer 2

Vascular- spinal epidural hematoma, spinal cord infarction
Infectious- spinal epidural abscess, discitis, vertebral osteomyelitis, potts disease
Neoplastic- mets, referred pain, primary spinal tumors
Degenerative- degenerative disc disease, spondylosis, spinal stenosis, spondylolisthesis, facet joint OA, compression fractures
Iatrogenic - surgical site infection, nerve injury, scar tissue formation, steroid osteoporosis, epidural, nerve block, spinal manipulation
Congenital - scoliosis, spina bifida, marfan
Inflammatory/autoimmune- ankylosing spondylitis, psooriatic arthritis, reactive arthritis
Traumatic - vertebral fracture, disc prolpase, whiplash, SC injury
Endocrine/ metabolic - osteoporosis, paget’s , hyperparathyroidism, rickets

Question 3

`Red and yellow flags for back pain

Answer 3

Red: Trauma, unexplained wt loss, neuro signs, Age <19, >50, Fever and unstable vitals, IVDU, steroids and anticoags, Hx of ca, no relief with rest, worse at night, progressive/ persistent despite >4weeks of conservative management

Yellow: avoiding activity, low mood and social w/d, belief in passive not active tx, belief that bac pain is disabling

Question 4

Management of compressive spinal emergencies

Answer 4

Urgent surgical decompression
Treat underlying
Suspected malignant cord compression- give high dose IV dexamethasone
Urinary catheter

Question 5

Management of vertebral fractures

Answer 5

Immediate spinal precautions
If unstable or with cord compression then urgent neurosurg consult,
If stable, conservative