9 - Back pain

Question 1

how much back pain is potentially serious

Answer 1

5-10%

Question 2

2 main classes of non-traumatic serious back pain

Answer 2

1. spinal

2. vascular

Question 3

3 spinal causes

Answer 3

1. cauda equina and cord compression
   - CA
   - epidural abcess
   - epidural hematoma
   - disc herniation
2. osteomyelitis
3. transverse myelitis

Question 4

5 vascular causes

Answer 4

1. aortic dissection
2. rupturing AAA
3. PE
4. MI
5. retroperitoneal bleed

Question 5

11 red flags for something more serious

Answer 5

1. constitutional Sx
2. IV drug use
3. immunocomromised
4. pain worse at night
5. urinary retention and fecal incontinence
6. CA Hx
7. spinous process tenderness
8. saddle anesthesia
9. neurodeficit at several levels
10. anti-coag use or bleeding disorders
11. recent invasive spine surgery

Question 6

what does cough or valsalva pain idicate

Answer 6

disc

Question 7

classic triad of epidural abcess

Answer 7

1. fever
2. back pain
3. neuro deficits
   - only 13% of time

Question 8

PHx maneuvers

Answer 8

1. vitals
2. inpect
3. abdo exam for AA
4. straight leg raise
5. neuro exam of each nerve root
6. saddle sensation

Question 9

investigations for someone fitting slipped disc and no red flags

Answer 9

none

Question 10

invest for AAA

Answer 10

US

Question 11

invest for CA or infections

Answer 11

CRP or ESR

Question 12

other invest.

Answer 12

1. cutures for infection
2. urinalysis for renal
3. post void residual for cauda equina
4. CXR for red flags for CA
5. MRI for cauda equina or an cord compression

Question 13

Tx of strain and hernaiation

Answer 13

• activity as tolerated
• no rest
• low potency pain killers
• no Tx
• ## follow up with primary care in 4-6 weeks if not better

Question 14

Tx of spinal infection

Answer 14

• IV ABx - #rd gen ceph

- consult ID and neuro

Question 15

Tx of cauda equina

Answer 15

• IV opioids
• IV dexa
• neuro surg