What are the causes of mechanical back pain?
- Lumbar strain/sprain
- Degenerative discs/joints (increase with flexion, sitting, sneezing)
- Degenerative facets/joints (more localised, increased with extension)
- Compression fractures (radiates in belt around chest/abdomen, sudden onset, associated osteoporosis)
What are the differences between inflammatory and mechancal back pain?
What are the red flags for back pain?
- Saddle anaesthesia
- Reduced anal tone
- Hip or knee weakness
- Generalised neurological deficit
- Progressive spinal deformity
What are yellow flags for back pain? (ABCDEFW)
- Attitudes – towards the current problem
- Beliefs – misguided belief that they have something serious
- Compensation – awaiting payment for an accident/RTA?
- Diagnosis – inappropriate communication, patients misunderstanding what is meant
- Emotions – other emotional difficulties (i.e. depression, anxiety)
- Family – either over bearing or under supportive
- Work relationship
What are the features of disc prolapse?
- Herniated nucleus pulposus
- May be acute
- Straight-leg raise test positive
- Leg pain in dermatomal distribution
- Reduced reflexes
- Sciatica and radiculopathy
- Can lead to Cauda equina syndrome (bilateral sciatica, saddle anaesthesia, reduced anal tone, needs urgent neurosurgical review)
What are the features of infective discitis?
- Fever, weight loss
- Constant back pain
- Immunosuppressed, diabetes, IVDU
- Most commonly staphylococcus aureus
- IV antibiotics and surgical debridement
What are the features of malignany back pain?
- History of malignancy (lung, prostate, thyroid, kidney, breast)
- Constant pain, worse at night
- Systemic symptoms
What are the clinical and radiological criteria for ankylosing sponditis?
- Low back pain and stiffness for >3 months, improves with exercise but not relieved by rest
- Limitation of motion of lumbar spine and chest expansion
- Sacrolitis grade ≥2 bilaterally or 3-4 unilaterally
What are the features of spondylolisthesis?
- Pars-interarticularis defect, asymptomatic in most
- Pain may radiate to posterior thigh
- Increase with extension
What are the features of spinal stenosis?
- Anatomical narrowing spinal canal
- Congenital and/or degenerative
- Often presents with 'claudication' in legs/calves (worse walking, rest in flexed position)
What conditions cause referred pain in the back?
- Aortic aneurysm
- Acute pancreatitis
- Peptic ulcer disease
- Acute pyelonephritis/renal colic