- 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)