Low Back Pain with a normal xray
Download as PPTX, PDF2 likes1,442 views
This document discusses various cases of acute low back pain and differential diagnoses. It describes 25 and 45 year old men who developed acute low back pain after lifting objects. Red flags for more serious underlying causes are described, including nocturnal pain, pain at rest, and neurological deficits. Conditions that can mimic back pain are outlined, such as pregnancy, infections, abdominal issues, and inflammatory diseases. Specific cases of conditions like pancreatitis, aneurysm, ankylosing spondylitis, and depression are also mentioned. The document provides guidance on evaluating for more serious potential causes of back pain like fractures, tumors, and epidural metastases.
Low Back Pain with a normal xray
- 1. Acute Low Back Pain with a normal X-ray Spiro Antoniades, M.D. Upper Chesapeake Health Spine Center 10/2/15
- 2. 25 yo man acute LBP After lifting a dresser up Steps, stiff painful cannot Put on his sox no sciatica
- 4. 45 yo man acute LBP After picking up a pencil With h/o mild LBP for 20 y
- 5. Red flag Nocturnal pain Pain at rest improves with activity Progressive neurological deficit Suspicious for cancer or infection
- 8. High index of suspicion H/O cancer Osteoporosis/steroids/immunosuppression AS 10/10 Weight loss IVDA UTI/sepsis
- 13. 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
- 16. Pancreatitis
- 21. AAA
- 27. AS
- 28. Sacroiliitis 30 year old man with LBP HLAB27+
- 30. Synovitis, subchondral edema, iliac side more common
- 32. Brown tumor
- 34. Psychosocial Issues Fear Anxiety Financial problems Anger Depression Job dissatisfaction Family problems Stress
- 35. 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
- 37. 66 wf LBP urosepsis(E Coli blood and urine) claustrophobia
- 41. Occult Fracture 75 wm severe! LBP S/P cement 6 months ago 65 year old man with Recurrent LBP that is severe
- 44. Tumor: vertebral body Vertebral body met
- 46. 48 year old woman severe LBP for six months despite swimming, NSAID, PT, muscle relaxers, opiates, injections
- 48. 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
- 51. Thanks!
- 52. 48 year old man with three week H/O severe neck pain with no improvement with 2 weeks of prednisone/narcotics/muscle relaxers
- 55. 75 year old man severe neck pain