Lecture Low Back Paine with a normal xray 2021
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This document summarizes a spine conference presentation on acute low back pain with a normal x-ray. It discusses the evaluation and differential diagnosis of back pain, including red flags indicating more serious underlying causes. Non-spine related causes like pregnancy, UTI, and abdominal issues are reviewed. Imaging findings, treatments including medications and injections, and psychosocial factors are also summarized. Case examples of different back pain presentations are provided.
Lecture Low Back Paine with a normal xray 2021
- 1. Acute Low Back Pain with a normal X-ray Spiro Antoniades, M.D. Spine conference 11/11/21
- 3. 25 yo man acute LBP After lifting a dresser up Steps, stiff painful cannot Put on his socks no sciatica
- 4. Disabling Uncertainty: better, worse, chronic, etiology? Common
- 5. Too much treatment, too little treatment, wrong treatment
- 11. Pfirmann: Spine 2001 Sep 1;26(17):1873-8.
- 15. Annulus Fibrosus
- 17. Herring
- 18. Fine fiber nerve ending staining in a rabbit disc The outer 3mm is innervated
- 19. Load with respect to posture of spine
- 23. Schmorl Node
- 25. Age versus degenerative changes on MRI on ASx patients
- 29. Tae Chi Yoga Mindfullness based Stress reduction techniques
- 33. Catastrophization: imagery, worst case scenario, anxiety,
- 35. reassurance
- 36. History Provoke, palliate, quality, region, severity, timing (onset/consistency/episodes: frequency of and length of episodes)
- 38. 45 yo man acute LBP After picking up a pencil With h/o mild LBP for 20 y
- 39. Red flag Nocturnal pain Pain at rest improves with activity Progressive neurological deficit Suspicious for cancer or infection
- 42. Inflammation of the disc Anti-inflammatory: steroids v NSAID (ibuprofen/meloxicam) Muscle relaxer: valium, Flexeril, soma, metaxalone, analgesic: Tylenol, tramadol, hydrocodone, oxycodone Gabapentin, Cymbalta
- 45. High index of suspicion H/O cancer Osteoporosis/steroids/immunosuppression AS 10/10 Weight loss IVDA UTI/sepsis
- 49. 35 year old woman with 7 month history of LBP right posterior thigh pain with new onset right vaginal numnbess
- 54. Differential Diagnosis Back Pain Not from the Spine Pregnancy Pregnancy with Labor Menstrual Period UTI Abdomen (cholecystitis, pancreatitis, aortic aneurysm, peptic ulcer disease, nephrolithiasis, pelvic inflammatory disease, diverticulitis) Inflammatory Arthropathy: Ankylosing Spondylitis, Lymes SI joint: infection, AS, hyperparathyroidism Depression
- 57. Pancreatitis
- 62. AAA
- 68. AS
- 69. Sacroiliitis 30 year old man with LBP HLAB27+
- 71. Synovitis, subchondral edema, iliac side more common
- 73. Brown tumor
- 75. Psychosocial Issues Fear Anxiety Financial problems Anger Depression Job dissatisfaction Family problems Stress
- 76. DSM-IV TR criteria for Major Depressive Episode (5 Sx for at least 2 weeks) 1. Depressed mood Markedly diminished interest or pleasure in all or almost all activities >5% weight loss or gain, change in apetite Insomnia or hyper somnia Psychomotor agitation or retardation Fatigue or loss of energy Feeling of worthlessness or inappropriate guilt Diminished concentration or indecisiveness Recurrent thoughts of death or suicide
- 77. 66 wf LBP urosepsis(E Coli blood and urine) claustrophobia
- 81. Occult Fracture 75 wm severe! LBP S/P cement 6 months ago 65 year old man with Recurrent LBP that is severe
- 84. Tumor: vertebral body Vertebral body met
- 86. Thanks!
- 92. 48 year old man with three week H/O severe neck pain with no improvement with 2 weeks of prednisone/narcotics/muscle relaxers
- 95. 75 year old man severe neck pain
- 99. 48 year old woman severe LBP for six months despite swimming, NSAID, PT, muscle relaxers, opiates, injections
- 101. 21 male severe! neck pain for three months with multiple ER visits for narcotics/physical therapy visits/feels clumsy/ three day history of difficulty walking following fall