The five Minute Orthopedic Consult, Rohit Robert Dhir BA Damien Doute MD A.

Jay Khanna MD

Nurul Hudayani C 111 06 100 Supervisor dr. Muh. Andry Usman, Sp.OT

Low back pain, the most common musculoskeletal condition Which affects the bones, joints, ligaments, and muscles of the back, The symptom that occurs primarily in middleaged adults, but it also may occur in children and adolescents.

Age:

Adults: Common Children: Uncommon:

Children and adolescents with scoliosis may have mild

pain. Severe back pain in children should alert the clinician to look for a potentially serious problem, such as a tumor or infection.

Gender
males > females higher rates of involvement with manual labor, motor vehicle injuries, and industrial accidents

Obesity Smoking Manual labor Accidents

Traumatic:

Fractures/microfractures (causes severe immediate back pain) Dislocations Herniated discs Ligament tears

Atraumatic:

Degenerative disc disease Degenerative spinal stenosis Inflammatory arthritis Osteoporosis Spondylolysis and spondylolisthesis Neoplasms Primary or metastatic tumor Infection

Symptoms:

Low back discomfort/pain Stiffness Numbness

Signs:
Paravertebral muscle spasm Motor weakness Loss of deep tendon reflexes Loss of sensation Clonus Positive Babinski sign

Physical Exam
Begin with a general inspection of the spine. Note any asymmetry of the ribs, flank, or pelvis, and inspect the natural sagittal curvatures of the patient. Assess ROM and determine local tenderness. Note flexion, extension, lateral bending, and rotation of the lumbosacral spine. Sudden pain accompanying movement is suggestive of a mechanical abnormality

Pain with extension is common in patients with facet

joint arthritis and spinal stenosis

Elicit paravertebral muscle spasms and percussion tenderness

Imaging Conventional radiographs, CT scans, MRI, and technetium bone scans should be used only to confirm pathology or rule out a specific diagnosis
CT Scan detecting bone abnormalities such as

fractures or osteoid osteomas. MRI detecting marrow abnormalities or soft-tissue processes such as metastatic bone disease

Adults:

Traumatic:

Atraumatic:

Herniated discs Compression fractures Fracture/dislocation

Degenerative disc disease Spinal stenosis Inflammatory arthritis: Rheumatoid arthritis, AS Spondylolysis and spondylolisthesis Ligament strains Neoplasms: Metastatic bone disease, multiple myeloma

Children:

Traumatic:

Atraumatic:

Herniated disc Fracture

Scoliosis Disc space infection Vertebral osteomyelitis Neoplasms

Most patients with low back pain can be treated nonoperatively with short-term bed rest in the supine position, NSAIDs, and physical therapy to improve muscle strength of the lower back During the initial period of severe spasm and pain (usually 2-7 days), patients may have restricted mobility

Medication NSAIDs are the medications of choice for decreasing inflammation.

Generally, they are prescribed for an initial 4-6 weeks. If the pain resolves, the medication is discontinued

Physical Therapy Physical therapy increasing endurance and strength, lowers the recurrence rate and shortens the history of back pain Surgery Depends on the nature of the individual's problem) have several principles in common:
Decompression of any nerve root or spinal cord compression Fusion to achieve a stable spine Consideration of realignment and fusion to correct spinal deformities (i.e., scoliosis and spondylolisthesis)

The prognosis is good (not always excellent) in patients who do not have major structural abnormalities. Patients with major fusions can return to most activities, but they generally do not tolerate heavy work or repetitive loading of the back