What is mechanical LBP?
Pain arising from MSK structures of the spine
What is referred pain?
Pain that is perceived in a region remote from the actual source of the pain
What are the discriminating features of mLBP?
- most episodes resolve < 4 weeks
- back dominant pain
- poorly localized
- no neuro symptoms
- no red flags
- SLR negative
What are the defining features of mLBP?
- age 20-55
- 85-90% of LBP episodes
- bettered/worsened with positioning
- generally well, no systemic symptoms
How do we treat mLBP?
Treat
What is radicular pain?
Leg pain arising from inflammation or ischemia or a nerve root
What can cause radicular pain?
Disc herniation at L4-L5 or L5-S1
How does radicular pain differ from radiculopathy?
Radicular pain is sensitization-related (affects sensory fibres = shooting pain), while radiculopathy is neurological-related (affects motor fibres = conduction loss)
What are the discriminating features of radicular pain?
- leg dominant pain
- constant and severe
- neuro symptoms in leg
- SLR positive
What are the defining features of radicular pain?
- age 20-55
- 5-8% of LBP episodes
- always referred leg pain
- sharp, shooting pain
- better/worse with changes in movement
- generally well
How do we treat radicular pain?
Can be monitored or managed unless there is significant radiculopathy, failure to improve
What is ankylosing spondylitis?
Progressive chronic inflammatory arthropathy affecting the SI joints and axial skeleton
What is the pathology of AS?
Inflammation of joints causes fusion of bones = bamboo spine
What are the discriminating features of AS?
- younger age 15-40
- alternating buttock pain
- morning stiffness > 30 mins
- night pain
What are the defining features of AS?
- males more than females
- slow onset
- back pain better with exercise
- failure to improve after 3 months
- uveitis
What is the decision for AS?
Refer GP for follow-up
What is cauda equina syndrome?
Compression of dural sac and descending nerve roots below conus medullaris (L4)
What are the discriminating features of CES?
- new urinary retention
- new fecal incontinence
- new saddle anesthesia
What are the defining features of CES?
- age 20-55
- males more than females
- severe back pain
- radicular leg pain
- leg weakness
- rapidly progressing
What is the course of action for CES?
True emergency - escort/send to EMERG
What are the discriminating features of a spinal fracture?
- history of trauma
- abrasion/contusion from trauma
- more males than females
- age > 50 (higher for 65+
- prolonged steroid use (> 7.5 mg for 3 months)
What are the defining features of a spinal fracture?
- severe back pain
- may have kyphotic deformity
- difficulty WB
- history of osteoporosis
What is the course of action for a spinal fracture?
Urgent referral - send to EMERG
What is a spinal infection?
Involves osteomyelitis of the v body = infect IVD
