Orthopedics Book

http://www.fpnotebook.com/

Acute Low Back Pain

Aka: Acute Low Back Pain, Musculoskeletal Low Back Pain, Mechanical Low Back Pain, Low Back Pain, Lumbago
Advertisement
  1. See Also
    1. Lumbar Spine Anatomy
    2. Low Back Pain History
    3. Low Back Pain Red Flags
    4. Low Back Exam
    5. Differential Diagnosis of Low Back Pain
    6. Lumbar Disc Disease
    7. Low Back Pain Management
    8. Low Back Imaging
    9. Rheumatologic Conditions affecting the Low Back
    10. Low Back Pain in Children
    11. Low Back Pain in Teen Athletes
  2. Definition
    1. Low Back Pain
      1. Pain distribution between the costal angles and the gluteal folds
    2. Duration
      1. Acute: Less than 4 weeks
      2. Subacute: 4 to 12 weeks
      3. Chronic: More than 12 weeks
    3. Radiation
      1. Sciatica with pain radiating down one or both legs
  3. Epidemiology
    1. Age of onset: Typically first episode occurs between ages 20-40 years old
  4. History
    1. See Low Back Pain History
    2. See Serious Low Back Symptoms
  5. Exam
    1. See Low Back Exam
    2. See Lumbar Spine Anatomy
  6. 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
  7. 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. Indications: 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
        4. Prostate Specific Antigen (PSA)
          1. Consider in men over age 50
      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
  8. Evaluation: Acute Low Back Pain with radiculopathy past the knee (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
  9. 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
  10. 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
  11. Imaging
    1. See Low Back Imaging
    2. L-Spine XRay Indications
      1. Acute Low Back Pain with radiculopathy
      2. See Low Back Pain Red Flags
  12. Course
    1. Acute Low Back Pain (95%)
      1. Resolution in 1 week: 50%
      2. Resolution in 8 weeks: 90%
    2. Recurrent Low Back Pain
      1. Recurs in at least 25% of patients within 1-2 years
      2. Moderate to severe in at least a third of patients
    3. Chronic Low Back Pain (<5%)
  13. Management
    1. See Low Back Pain Management
    2. See Return to Work in Lumbar Back Pain
  14. References
    1. Arce (2001) Am Fam Physician 64(4):631-8
    2. Atlas (2001) J Gen Intern Med 16:123
    3. Bratton (1999) Am Fam Physician 60(8):2299-306
    4. Bueff (1996) Prim Care 23:345-64
    5. Jarvik (2002) Ann Intern Med 137:586-97
    6. Joines (2001) J Gen Intern Med 16:14-23
    7. Patel (2000) Am Fam Physician 61(6):1779-86
    8. Rose-Innes (1998) Geriatrics 53:26-40
    9. Swenson (1999) Neurol Clin 17:43-63

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
Concepts Sign or Symptom (T184)
MSH D017116
ICD9 724.2
ICD10 M54.5
SnomedCT 156648004, 40709005, 279039007, 202793005, 156651006, 268083007, 139421003, 267169009
English Back Pain, Low, Back Pains, Low, Low Back Pains, Lumbago, Low Back Ache, Low Backache, Lower Back Pain, Ache, Low Back, Aches, Low Back, Back Ache, Low, Back Aches, Low, Back Pain, Lower, Back Pains, Lower, Backache, Low, Backaches, Low, Low Back Aches, Low Backaches, Lower Back Pains, Pain, Lower Back, Pains, Lower Back, BACK PAIN, LOWER, LOW BACK PAIN, LUMBAGO, LUMBAR PAIN, Pain, Low Back, Pains, Low Back, Nonspecific pain lumbar region, Low back derangement syndrome, Lower back pain, Lumbago syndrome, low back pain (symptom), lower back pain, lumbago (diagnosis), lumbar back pain, lumbar pain, lumbago, low back pain, lbp, Lumbago (disorder), LBP, Low back ache, BACK PAIN LOWER BACK, BACK PAIN LUMBAR, Lumbago NOS, Low Back Pain [Disease/Finding], lumbalgia, Pain;back low, Pain;back;lumbar, low backache, low back pains, lower back pains, lumbar pains, Low back pain, Low back syndrome, Lumbalgia, LBP - Low back pain, Nonspecific pain in the lumbar region, Lumbar pain, back; pain, low, backache; low, low back; pain, low; backache, pain; back, low, pain; low back, syndrome; low back, LBP - low back pain, Lumbago (disorder) [Ambiguous], Low back pain (finding), Low back pain (disorder), Low Back Pain
Portuguese DOR LOMBAR, Moinha lombar, Dor lombar, Dor Lombar, Lombalgia, Lumbago
Dutch lumbago, pijn in de onderrug, lage rugpijn, lumbaalpijn, laag; rugpijn, lage rug; pijn, pijn; lage rug, pijn; onderste deel van rug, pijn; rug, laag, rug; pijn, laag, rugpijn; laag, syndroom; lage rug, Lage rugpijn, Lagerugpijn, Lumbago, Pijn, lagerug-
French Endolorissement de la région lombaire, Douleur dans la partie inférieure du dos, Douleur lombosacrale, DOULEUR LOMBAIRE, Douleur dorsale basse, Douleur lombaire basse, Douleur du bas du dos, Rachialgie lombo-sacrale, Rachialgie lombo-sacrée, Rachialgie lombosacrale, Rachialgie lombosacrée, Rachialgie lombaire, Lombalgie, Lumbago, Douleur lombaire, Douleur lombosacrée
German unterer Rueckenschmerz, unterer Rueckenschmerzen, lumbaler Schmerz, Kreuzschmerz, SCHMERZ LENDENGEGEND, Kreuzschmerzen, Lumbago, Lumbalsyndrom, Hexenschuß
Italian Dolore dorso-lombare, Lombalgia, Lombaggine, Dolore lombare
Spanish Dolor de la parte baja de la espalda, Dolor lumbar, dolor de espalda, LBP - low back pain, Lumbalgia, Low back pain, Lumbar pain, LBP - Low back pain, Lumbago, LUMBAR, DOLOR, dolor inespecífico en la región lumbar, dolor lumbar, lumbago, lumbalgia (concepto no activo), lumbalgia (hallazgo), lumbalgia (trastorno), lumbalgia, síndrome de dolor en la región inferior de la espalda, Dolor de la Región Lumbar, Dolor de la Region Lumbar
Swedish Ländryggssmärta
Japanese ﾖｳﾂｳｼｮｳ, ﾖｳﾂｳ, 腰痛, 腰痛症
Czech lumbalgie, bolest v kříži, lumbago, Bolest dolní poloviny zad, Bederní bolest, Lumbago, ústřel
Finnish Alaselkäkipu
Russian RADIKULIT POIASNICHNYI, LIUMBAGO, POIASNICHNYI RADIKULIT, ЛЮМБАГО, ПОЯСНИЧНЫЙ РАДИКУЛИТ, РАДИКУЛИТ ПОЯСНИЧНЫЙ
Korean 아래허리통증
Croatian LUMBOSAKRALGIJA
Polish Ból krzyża, Ból dolnego odcinka kręgosłupa, Lumbago, Ból okolicy lędźwiowo-krzyżowej
Hungarian Lumbago, Alsó háti fájdalom, derékfájás, Derékfájdalom, Lumbalis fájdalom
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Low Back Pain, Mechanical (C0423682)

Concepts Disease or Syndrome (T047)
MSH D017116
SnomedCT 279040009
Spanish dolor lumbar de causa mecánica ('trastorno), dolor lumbar de causa mecánica (hallazgo), dolor lumbar de causa mecánica
French Lombalgie mécanique
Italian Dolore lombare meccanico
English Mechanical Low Back Pain, mechanical low back pain, Mechanical low back pain, Mechanical low back pain (finding), Mechanical low back pain (disorder), Low Back Pain, Mechanical
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Acute low back pain (C0457950)

Concepts Sign or Symptom (T184)
SnomedCT 278862001, 202793005
Spanish lumbalgia aguda (trastorno), Acute back pain - lumbar, lumbalgia aguda (hallazgo), lumbalgia aguda
English Pain;back low;acute, acute back low pain, Acute back pain - lumbar, Acute low back pain, Acute low back pain (finding), Acute low back pain (disorder), acute low back pain
Sources
Derived from the NIH UMLS (Unified Medical Language System)


musculoskeletal lower back pain (C0848192)

Concepts Sign or Symptom (T184)
English Pain;musculoskeletal;low back, musculoskeletal lower back pain
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Navigation Tree