 5th most common condition

 ~25% adults report LBP w/in past 3

months
 Prevalence of 70% over the course of
one’s life
 >85% cannot be reliably attributed to
a specific disease or abnormality
 Classified into 3 broad categories:
1. Nonspecific LBP
2. Nerve Root Syndrome (CES, etc.)
3. Serious Spinal Pathology

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  Less common than nonspecific
 Potentially disabling condition
 Most often caused by acute lumbar
disc herniation
 Commonly between ages of 30 – 55

 Related to:
 Radiculopathy
 Spinal Stenosis
 Cauda Equina Syndrome

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  Rare and devastating condition
 Prevalence of ~0.04% of all patients
presenting w/ LBP
 “True neurologic emergency”

 Rapid clinical progression

 For optimal prognosis:
 Early recognition/diagnosis
 Immediate surgical referral
 Recommended w/in 48 hours of Dx

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  Spinal cord ends between vertebrae L1 & L2
 Originates after Conus Medullaris

 L2 to S5 nerve roots looks like horse’s tail

 Includes motor nerves, sensory nerves and
parasympathetic innervation of the bladder

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  Compressive causes
 Herniated lumbosacral disc
 Spinal stenosis
 Spinal neoplasm
 Fracture of vertebrae

 Non-compressive causes
 Ischemia
 Infection
 inflammation

Image Courtesy of www.publichealthwatchdog.com

Images Courtesy of www.publichealthwatchdog.com
  Making a thorough evaluation
 Continually monitoring patient’s status throughout the patient management
 Acting appropriately when conditions emerge that requires immediate referral

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 Crowell MS, Gill NW. Medical Screening and Evacuation: Cauda Equina
Syndrome in a Combat Zone. J Orthop Sports Phys Ther. 2009; 39(7):541-549.
 Moore KL, Dalley AF, Agur AMR, et al. Clinically Oriented Anatomy 7th Edition.
Lippincott Williams & Wilkins; 2013.