- 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.
Advances in low-back pain.
Predictors of low back pain disability.
x
Predicting disability from low back pain.
The facet syndrome. Myth or reality
Medical Progress: Back Pain And Sciatica.
Back pain and sciatica.
Frymoyer JW.
New England Journal of Medicine.
318(5):291-300, 1988 Feb 4.
