Diff Dx of Low Back Pain



- Age:
    - Back Pain in the Child:
    - Younger Adults:
         - ankylosing spondylitis (see spondyloarthropathies)
         - disc disease:
         - spondylothisthesis
         - metabolic bone disease
              - indicated by anterior vertebral body wedging and osteoporosis out of proportion for age;
         - acute fractures;
         - spinal instability;
              - patients note that pain becomes worsened w/ activity and erect posture and is releived w/ rest and recumbency;
    - Older Adults:
         - spinal stenosis
         - metastatic disease / tumors
         - osteoporotic compression fractures are more common;
         - hip arthritis
         - degenerative facet disease
         - zoster: may occur in patients with weakened immune systems (from steroids or older age);

- Non Radicular Symptoms:
    - annular tear
    - discogenic pain
    - compression fractures
    - lumbar stenosis
    - osteoporotic compression fractures:
         - progressive loss of stature rsults in progressive shortening of paraspinal musculature, that is, paraspinal muscles are actively 
                contracting resulting in pain of muscle fatigue;
         - this is the major cause of back pain in spinal osteoporosis;
         - careful clinical exam reveals that skeleton (spine) itself is not tender and most patients indicate that pain is paraspinal;
         - consider calcitonin
    - facet joint arthropathy:
         - this type of arthrosis may occur following disc degenerative disease (resulting from abnormal motion and stresses);
         - the normal intact anulus and longitudinal ligaments protect the facet from abnormal stress and loading;
         - ref: Osteoarthrosis of the facet joints resulting from anular rim lesions in sheep lumbar discs.

- Radicular Symtoms:
    - often associated with disc herniation or spinal stenosis;
    - intra-spinal pathology (tumors) or other entities associated resposible;
    - herpes zoster is a rare cause of lumbar radiculopathy with pain preceding the skin eruption;

- Systemic Symptoms:
    - careful history taking can lead to the diagnosis of metabolic disease
         - AS, Infection, Spondyloarthropathies (ophthalmologic);

- Referred Back Pain;
    - AAA and Vascular Dz;
    - Visceral (ulcer, PID, endometriosis, gallbladder disease, pleural disease);
    - Infection - UTI, PID;
    - Hip Arthritis;

- Iatrogenic Back Pain:
    - dural adhesions and nerve root adhesions
    - pseudoarthrosis;
    - post surgical instability
    - arachnoiditis
    - post operative discitis;

- Psychogenic Back Pain: (Waddel Criteria)


The role of sacroiliac joint dysfunction in the genesis of low back pain: the obvious is not always right



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, April 11, 2012 4:28 pm