Low Back Pain with a normal xray
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Transcript of Low Back Pain with a normal xray
Acute Low Back Pain
with a normal X-ray
Spiro Antoniades, M.D.Upper Chesapeake Health Spine Center
10/2/15
25 yo man acute LBPAfter lifting a dresser up Steps, stiff painful cannotPut on his sox no sciatica
45 yo man acute LBPAfter picking up a pencilWith h/o mild LBP for 20 y
Red flag
Nocturnal pain
Pain at rest improves with activity
Progressive neurological deficit
Suspicious for cancer or infection
High index of suspicion
H/O cancer
Osteoporosis/steroids/immunosuppression
AS
10/10
Weight loss
IVDA
UTI/sepsis
Cauda Equina Syndrome
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
Pancreatitis
LaborPregnancyMenstrual period
AAA
AS
Sacroiliitis
30 year old man with LBP HLAB27+
Synovitis, subchondral edema, iliac side more common
Brown tumor
Psychosocial Issues
Fear
Anxiety
Financial problems
Anger
Depression
Job dissatisfaction
Family problems
Stress
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
66 wf LBP urosepsis(E Coli blood and urine) claustrophobia
Occult Fracture
75 wm severe! LBP S/P cement 6 months ago
65 year old man with Recurrent LBP that is severe
Tumor: vertebral body Vertebral body met
Epidural metastasis
48 year old woman severe LBP for six months despite swimming,
NSAID, PT, muscle relaxers, opiates, injections
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
Thanks!
48 year old man with three week H/O severe neck pain with no improvement with
2 weeks of prednisone/narcotics/muscle relaxers
75 year old man severe neck pain