emDocs - Februaru 10, 2016 - By Anton Helman - Originally published at EM Cases
APPROACH TO LOW BACK PAIN EMERGENCIES
Main categories of patients with acute back pain:
- nonspecific lumbosacral pain/strain
- radicular pain or sciatica
- emergent pathologies.
The 5 emergent pathologies are:
- infection such as osteomyelitis, or spinal epidural abscess,
- fracture (trauma or pathologic),
- disk herniation & cord compression,
- cancer in spine causing cord compression,
- vascular – leaking/ruptured AAA, retroperitoneal bleed, and spinal epidural hematoma.
Red flags for Low Back Pain Emergencies
- Age <18 or >60,
- Symptoms or history of cancer,
- Immunodeficiency (including diabetes, IVDU), previous spinal interventions, or recent infections,
- Pain not resolved by analgesia,
- History of trauma or coagulopathy,
- Cauda equina/cord compression symptoms (bowel, bladder or erectile dysfunction, saddle paresthesia, progressive bilateral leg weakness)
Pearls: *Constant, unrelenting, severe pain, especially if it is worse lying down is a red flag for infection or cancer.* Discogenic pain is worse with flexion, and spain from spondylolysis is worse with extension