- Discussion:
- plain radiographs:
- in low risk patients, radiographs are indicated if LBP does not improve after 6 weeks;
- low risk implies that the patient is between 18-50 years, acute onset, absence of night pain, no recent wt loss,
no neurologic symptoms;
- radiographs are helpful in diagnosing spondylosis or spondylolithesis, and destructive lesions (from tumor; or infection);
- dynamic radiographs:
- normal anterior and posterior translation from L1 to L5 is about 8% of length of vertebral body or about 3-4 mm;
- radiographic findings: (not necessarily indicative of pain)
- Schmorl's nodes
- spina bifida occulta;
- lumbarization;
- sacralization;
- scoliosis;
- lordosis;
- osteophytes and spurs:
- traction osteophytes (associated w/ instability)
- marginal syndesmophytes: (AS, Inflammortory bowel disease);
- non marginal syndesmophytes: (DISH, Reiters and Psoriasis)
- age related changes may include:
- loss of disk height
- vaccum phenomenon (loss of disc height leads to facet joint loading);
- end plate sclerosis
- facet arthropathy;
- relative indications: (for ordering x-rays in patients w/ back pain)
- age greater than 50 yrs;
- history of cancer;
- temp greater than 38;
- nerve deficit;
- recent wt loss;
- pain at rest;
- references:
- Spine radiographs in patients with low-back pain. An epidemiological study in men.
- Bone Scan:
- may help rule out infection or occult metastatic tumor;
- CT Myelogram:
- allows accurate assesment of lumbar stensosis;
- can detect far lateral disc herniation;
- MRI of Spine:
Electrophysiologic mapping of the segmental anatomy of the muscles of the lower extremity.
Recognizing specific characteristics of nonspecific low back pain.
Predictors of low back pain disability.
Predicting disability from low back pain.
The facet syndrome. Myth or reality
Medical Progress: Back Pain And Sciatica.