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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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domingo, 14 de febrero de 2016

Lower Back Pain

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