- 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;
RJ Moore et al. Spine. March 1999. Vol 24. No 6. P 519-525.
- 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
