Acute Low Back Pain

with a normal X-ray

Spiro Antoniades, M.D.Upper Chesapeake Health Spine Center

10/2/15

25 yo man acute LBPAfter lifting a dresser up Steps, stiff painful cannotPut on his sox no sciatica

45 yo man acute LBPAfter picking up a pencilWith h/o mild LBP for 20 y

Red flag

Nocturnal pain

Pain at rest improves with activity

Progressive neurological deficit

Suspicious for cancer or infection

High index of suspicion

H/O cancer

Osteoporosis/steroids/immunosuppression

AS

10/10

Weight loss

IVDA

UTI/sepsis

Cauda Equina Syndrome

Differential Diagnosis Back Pain

Not from the Spine Pregnancy

Pregnancy with Labor

Menstrual Period

UTI

Abdomen (cholecystitis, pancreatitis, aortic aneurysm, peptic ulcer disease, nephrolithiasis, pelvic inflammatory disease, diverticulitis)

Inflammatory Arthropathy: Ankylosing Spondylitis, Lymes

SI joint: infection, AS, hyperparathyroidism

Depression

Pancreatitis

LaborPregnancyMenstrual period

AAA

AS

Sacroiliitis

30 year old man with LBP HLAB27+

Synovitis, subchondral edema, iliac side more common

Brown tumor

Psychosocial Issues

Fear

Anxiety

Financial problems

Anger

Depression

Job dissatisfaction

Family problems

Stress

DSM-IV TR criteria for Major

Depressive Episode (5 Sx for at

least 2 weeks) 1. Depressed mood

Markedly diminished interest or pleasure in all or almost all activities

>5% weight loss or gain, change in apetite

Insomnia or hyper somnia

Psychomotor agitation or retardation

Fatigue or loss of energy

Feeling of worthlessness or inappropriate guilt

Diminished concentration or indecisiveness

Recurrent thoughts of death or suicide

66 wf LBP urosepsis(E Coli blood and urine) claustrophobia

Occult Fracture

75 wm severe! LBP S/P cement 6 months ago

65 year old man with Recurrent LBP that is severe

Tumor: vertebral body Vertebral body met

Epidural metastasis

48 year old woman severe LBP for six months despite swimming,

NSAID, PT, muscle relaxers, opiates, injections

21 male severe! neck pain for three months with multiple ER

visits for narcotics/physical therapy visits/feels clumsy/ three

day history of difficulty walking following fall

Thanks!

48 year old man with three week H/O severe neck pain with no improvement with

2 weeks of prednisone/narcotics/muscle relaxers

75 year old man severe neck pain