Flashcards in Low Back Pain Deck (19)
What is the most common cause of disability for patients under the age of 45 and is the 2nd most common cause for primary cause visits?
low back pain
The annual prevalence of LBP is __-__%
Approximately __% episodes of LBP resolve within 3 weeks and __% resolve within 6 weeks
What are the alarming symptoms for LBP caused by cancer?
- unexplained weight loss
- failure to improve with treatment
- pain for more than 6 weeks
- pain at night or during rest
What are 2 other risk factors for malignancy?
History of cancer and age greater than 50
What are the alarming symptoms for LBP caused by infection?
- rest pain
- recent infection (UTI, cellulitis, pneumonia)
- history of immunocompromise or injection use
What suggests LBP caused by cauda equina syndrome?
- urinary retention or incontinence
- saddle anesthesia
- decreased anal sphincter tone or fecal incontinence
- bilateral LE weakness
- progressive neurological deficits
What suggests LBP caused by fracture?
- corticosteroid use
- age greater than 70
- history of osteoporosis
- recent significant fracture
- very severe focal pain
LBP may also be the presenting symptom is what other serious medical problems?
- abdominal aortic aneurisms
- peptic ulcer disease
- kidney stones
A positive one-leg standing extension test may indicate what?
- pars interarticularis fractures (spondylosis or spondylolisthesis)
- facet joint arthritis
What 4 symptoms suggest nonorthopedic causes for LBP or malingering?
- superficial skin tenderness to light tough of the lumbar spine
- overreaction to maneuvers in the regular back examination
- LBP on axial loading of spine in standing
- inconsistency in the SLR test or on the neuro exam
In the absence of red flag symptoms suggesting infection, malignancy, or cauda equnia syndrome diagnostic imaging is not typically recommended for the first _ weeks
What special tests may be performed in assessing patients with possible nerve root symptoms lasting longer than 6 weeks?
electromyography or nerve conduction studies
What things can be done to conservatively treat LBP?
- proper lightning technique instruction
- core strengthening
- weight loss
- smoking cessation
True or False
NSAIDs are effective in the early treatment of LBP
What are the surgical indications for back surgery?
- cauda equina syndrome
- ongoing morbidity with no response to conservative treatment for over 6 months
- severe spinal deformity
When is surgical prognosis improved?
When there is an anatomic lesion that can be corrected and symptoms are neurologic
What are some possible surgical complications?
- persistent pain
- surgical site pain
- neurologic damage
- cutaneous nerve damage
- implant failure