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Flashcards in Spine - Head - Neck - Back Deck (7)
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1

5 Red Flags when screening for Vertebral Fractures

  1. age >50
  2. female 
  3. major trauma - esp with corticosteriod use
  4. pain and tenderness
  5. distracting, painful injury

2

What is the primary goald of clinical examination of an individual with acute low back pain?

To identify patients who require immediate surgical evaluation and those whose symptoms suggest a more serious underlying condition 

  • diagnostic imaging is appropriate for progressive motor sensory deficit, saddle anesthesia, bilateral sciatica or leg weakness and difficulty urinating, ecal insentience are all justified for asking MD
  • the more red flags the more justified you become 

3

Cauda Equina Signs and Symptoms

  1. progressive neurologic deficits
  2. bowel or bladder dysfunction
  3. bilateral sciatica or weakness
  4. numbness in saddle distribution
  5. ALL REQUIRE MEDICAL REFERRAL

4

Treatment Options for Low back

  • NSAIDs = recommended for tx, strong evidence
  • Opioids = little evidence, no sig advantage comapred to NSAIDs
  • Muscle RElaxants = Strong evidence, helpful for non specific 
  • Corticosteriods = oral steriods are NOT supported
  • Bed rest = strong evidence, activity is better
  • Pt education = may speed recovery process, limited evidence
  • Exercise therapy = specific back exercises are not helpful
  • Massage = limited evidence, considered safe
  • Acupuncture = limited evidence, mixed
  • Heat/Ice = heat foudn to be helpful in reducing pain and increasing function
  • Manipulation = some evidence supports short term 
  • Physical Therapy = McKenzie method is superior in short term pain relief, strong evidence that traction does NOT improve pts with sciatica long term 

5

Acute Back Pain - Major Red Flags

  • gradual onset of back pain
  • age <20 or >50
  • thoracic back pain and isolated
  • pain lasting >6wks
  • h/o trauma
  • fever/chills/sweats
  • unintentional weight loss
  • p! increases with recumbancy or at night
  • unrelenting pain despite analgesics 
  • h/o malignancy
  • h/o immunosuppression
  • h/o IV drugs
  • hypotension
  • extreme HTN
  • pale
  • spinous process tenderness
  • focal neurological signs 
  • acute urinary retention 

6

Red Flag Pain Signs with Back Pain

  • Onset - gradual, <20 or >50
  • location - thoracic (isolated) localized to midline
  • Duration - persists longer than 6wks
  • Context - p! after trauma, elderly, procedure
  • Associated: neurologic, parasthesias, motor weakness, urinary or fecal incontinence, 
  • aggravating: laying down, p! at night
  • alleviating: p! improves with sitting = stenosis, 

7