​Low Back Pain: Causes, Symptoms, Diagnosis, and Treatment скачать в хорошем качестве

​Low Back Pain: Causes, Symptoms, Diagnosis, and Treatment

Experiencing low back pain can be concerning, and it's essential to distinguish between common causes and more serious conditions. In this video, we guide you through the critical steps of evaluating low back pain, emphasizing the importance of early detection and appropriate treatment.​ Key Discussion Points: Initial Assessment: When a patient presents with low back pain, the first question should be about any bladder or bowel dysfunction. These symptoms could indicate cauda equina syndrome, a medical emergency requiring prompt surgical intervention. Early diagnosis is crucial to prevent permanent neurological damage.​ Conservative Management: Most cases of acute low back pain, including those with sciatica (pain radiating to the leg and foot), respond well to conservative treatments over six weeks. This approach includes physiotherapy, anti-inflammatory medications, and activity modification based on pain levels. Even with significant disc findings on MRI, a six-week conservative treatment is often recommended, as 90% of patients experience symptom resolution within one month.​ Risk Factors: Factors such as smoking, depression, and exposure to vibration can increase the incidence of low back pain. Understanding these can aid in both prevention and management.​ Spinal Load and Posture: Intradiscal pressure varies with body position. The lowest pressure occurs when lying supine, while the highest is when sitting, leaning forward, and holding weight.​ Red Flags for Serious Conditions: History of Cancer: Patients with a cancer history presenting with low back pain, especially if the pain persists at rest or during the night, should undergo immediate imaging (X-ray and MRI). The spine is a common site for metastasis, often affecting the vertebral body and pedicles. Notably, approximately 30-40% of bone mass loss is necessary before lesions become detectable on X-rays, leading to signs like the "winking owl" (loss of a pedicle).​ Infection Indicators: Spinal infections typically involve the disc space and present with elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. Only about 50% of patients exhibit fever, and fewer than 50% have elevated white blood cell counts. Blood cultures are positive in approximately 24% of cases. MRI is the imaging modality of choice, and antibiotic therapy should be guided by biopsy, culture, and sensitivity results. In cases of epidural abscess with neurological decline, surgical intervention is often necessary.​ Osteoporotic Fractures: Osteoporosis-related fractures commonly occur first in the wrist, followed by the spine and hip. A single vertebral fracture increases the risk of subsequent fractures. After one year of appropriate treatment, the incidence of vertebral fractures decreases by 60%, and by 40% after two years. Early intervention is vital to prevent progression to more severe fractures, such as those of the hip.​ Imaging Guidelines: Routine X-rays are generally unnecessary within the first four to six weeks of low back pain unless red flags are present, including advanced age, history of cancer, suspected infection, trauma, or potential osteoporotic fractures (e.g., long-term steroid use). In such cases, X-rays are warranted, and findings may suggest conditions like ankylosing spondylitis, which often begins at the sacroiliac joints. Testing for HLA-B27 and observing features like marginal syndesmophytes with diffuse disc space ossification (without large osteophyte formation) can aid in diagnosis. This presentation differs from diffuse idiopathic skeletal hyperostosis (DISH), commonly seen in diabetic patients, characterized by non-marginal syndesmophytes and larger osteophytes. DISH typically presents with flowing ossification along the anterolateral aspect of at least four contiguous vertebrae, distinguishing it from ankylosing spondylitis.​ MRI Considerations: While MRIs are valuable, they have limitations:​ Asymptomatic Findings: A significant number of asymptomatic individuals exhibit abnormal MRI results—approximately 35% in those under 40 and up to 90% in those over 60.​ Postoperative Assessment: Gadolinium-enhanced MRI can differentiate between recurrent disc herniation and scar tissue. Granulation tissue (scar) is vascular and enhances with contrast, whereas a recurrent disc (avascular) does not. This distinction is crucial for determining the need for further surgical intervention.​ Understanding these aspects ensures timely and appropriate management of low back pain, improving patient outcomes. Always consult with a healthcare professional for personalized advice and treatment options.