LOWER  BACK  PAIN (LBP)

 

Etiology:

  1. Musculoskeletal (muscle, ligament, bone), Arthritis, Fx of spinal bone, Herniated disc, Spinal stenosis.
     
  2. Referred pain (H. Zoster, Pancreatitis, AAA, UTI), Metastasis to spine, Other underlying medical conditions (Rheumatic diseases, Trauma, IBD, Osteoporosis, Psoriatic arthritis), Spinal abscess (sp surgery, IVDA, recent LP), Osteomyelitis.

S & S:

  1. These could be 2ry  to:
    1. Simple c/o pain to lower back if  it is musculoskeletal
       
    2. Radicular (Sciatica)
       
    3. Cord involvement -associated with numbness, sphincter dysfunction, weakness to LE abnormal  reflexes (in case of neurological involvement 2ry to herniated disc, spinal metastasis, hematoma,  abscess, etc.)

DX:

  1. Pt without neuro deficit is able to raise leg > 40-60%, has good motor strength, intact DTR of knee (assesses L 2,3,4) and DTR of ankle (assesses S1,2) and intact sensory (assessed by touching  skin with pin and plotting the findings on "Dermatome Chart")
    .
  2. Depending on history and exam obtained, diagnostic tools available to ER personnel is:
    1. Xray
       
    2. CT with myelogram
       
    3. MR
      I
    4. Bone scan.
       
    5. In addition, UA, Amylase, CBC/ESR etc. are  obtained  as dictated by exam and history.

Treatment:

  1. Musculoskeletal pain usually resolves with NSAIDs and +/- bed rest or modified activity. 60% of pts feel better within 1 week and 90% within 2-3 months.
     
  2. Pts who have neuro deficit must have appropriate consult (neurology, neurosurgery) in ER.

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