Orthopedics Book

Foot Disorders

Hand Disorders

Hip Disorders

Knee Disorders

Lumbar Spine Disorders

Miscellaneous

Shoulder Disorders

Wrist Disorders

http://www.fpnotebook.com/

Acute Low Back PainAka: Musculoskeletal Low Back Pain, Low Back Pain, Lumbago

Advertisement

  1. See Also
    1. Rheumatologic Conditions affecting the Low Back
    2. Low Back Pain in Children
    3. Low Back Pain in Teen Athletes
  2. Definition
    1. Acute Low Back Pain for less than 3 months
  3. History
    1. See Low Back Pain History
    2. See Serious Low Back Symptoms
  4. Exam
    1. See Low Back Exam
  5. Evaluation: Acute Low Back pain without radicular symptoms (93%)
    1. Simple musculoskeletal low back pain
      1. Indicated if no Low Back Pain Red Flags
      2. Conservative therapy for 6 weeks
        1. Evaluate as in complicated back pain below
    2. Complicated low back pain
      1. Risk of cancer or infection
        1. See Low Back Pain Red Flags
      2. Lab work
        1. Complete Blood Count
        2. Urinalysis
        3. Erythrocyte Sedimentation Rate (ESR)
          1. Highly suggestive if ESR >50 mm per hour
      3. Initial Imaging: L-Spine XRay Indications
        1. Risk factors for non-mechanical cause (see above)
        2. Erythrocyte Sedimentation Rate (ESR) >20 mm/hour
        3. Low Back Pain Red Flags
      4. Additional management if indicated by XRay or ESR
        1. Consider MRI Spine (preferred imaging)
        2. Consider Bone Scan
        3. Consider orthopedic consultation
  6. Evaluation: Acute Low Back Pain with radiculopathy (4%)
    1. See Lumbar Disc Herniation
    2. Conservative management in 99% of cases
      1. Indicated if no indications for urgent evaluation
      2. CT or MRI Spine if not improving by 6 weeks
    3. Urgent evaluation in 1% of cases
      1. Indications
        1. Cauda Equina Syndrome
        2. Rapid progression of neurologic deficit
        3. Urinary Retention
        4. Saddle anesthesia
        5. Bilateral neurologic deficit
      2. Protocol
        1. Immediate consultation for possible discectomy
        2. MRI lumbosacral spine
  7. Evaluation: Acute Low back pain suggestive of Lumbar Stenosis (3%)
    1. Indication
      1. Seen in older patients
      2. Leg and back pain relieved when sitting
    2. Conservative management in most cases
    3. Evaluation for more significant stenosis
      1. Indications
        1. Failed conservative therapy
        2. Intolerable symptoms
        3. Neurologic deficit
      2. Protocol
        1. CT or MRI Spine
        2. Consultation for possible laminectomy
  8. Evaluation: Acute Low Back Pain Suggestive of Vertebral Fracture
    1. Obtain L-Spine XRay
    2. Negative XRay and persistent symptoms >10 days
      1. Consider bone scan or CT Spine
      2. Consider orthopedic consultation
  9. Imaging: L-Spine XRay Indications
    1. Acute low back pain with radiculopathy
    2. See Low Back Pain Red Flags
  10. Differential Diagnosis
    1. Mechanical Causes (90%)
    2. Non-mechanical Causes
      1. Spondyloarthropathy
        1. Ankylosing Spondylitis
        2. Reiter's Syndrome
      2. Spinal Infection
      3. Osteoporosis
      4. Cancer
      5. Referred visceral pain
        1. Abdominal Aortic Aneurysm
        2. Pancreatic Cancer
        3. Genitourinary cancer
      6. Lumbar Stenosis
      7. Cauda Equina Syndrome
  11. Course
    1. Acute Low Back Pain (95%)
      1. Resolution in 1 week: 50%
      2. Resolution in 8 weeks: 90%
    2. Subacute low back pain
      1. Low back pain persists <12 weeks
    3. Chronic Low Back Pain (<5%)
  12. Management
    1. See Low Back Pain Management
    2. See Return to Work in Lumbar Back Pain
  13. References
    1. Arce (2001) Am Fam Physician 64(4):631
    2. Atlas (2001) J Gen Intern Med 16:123
    3. Bratton (1999) Am Fam Physician 60(8):2299
    4. Bueff (1996) Prim Care 23:345
    5. Jarvik (2002) Ann Intern Med 137:586
    6. Joines (2001) J Gen Intern Med 16:14
    7. Patel (2000) Am Fam Physician 61(6):1779
    8. Rose-Innes (1998) {a 6657} 53:26
    9. Swenson (1999) Neurol Clin 17:43

Low Back Pain (C0024031)

Definition (MSH)Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous SPRAINS AND STRAINS; INTERVERTEBRAL DISK DISPLACEMENT; and other conditions.
Definition (AOT)see:http://www.nlm.nih.gov/mesh/MBrowser.html
ConceptsSign or Symptom (T184)
ICD9724.2, 724.2
MSHD017116
EnglishLBP - Low back pain, Low Back Ache, Low Back Aches, Low Back Pain, Low Back Pains, Low back syndrome, Low Backache, Low Backaches, Lower Back Pain, Lower Back Pains, Lumbago, Lumbalgia, Lumbar pain, Nonspecific pain in the lumbar region
Spanishdolor de espalda, dolor inespecifico en la region lumbar, dolor lumbar, lumbago, lumbalgia, sindrome de dolor en la region inferior de la espalda
Parent Conceptsspinal symptom and disorder (C0679389), Authorized Osteopathic Thesaurus (C1704485), Other and unspecified back disorders (C0158298), Back Pain (C0004604), General finding of abdomen (C0577118), Ambiguous concept (C1274012), Abdominal Pain (C0000737), Duplicate concept (C1274013)
SourcesAOD, AOT, CCS, COSTAR, CST, DXP, ICD9CM, MSH, MTH, MTHICD9, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree