Low Back Pain: Simple or Complicated? Understanding the Key Differences скачать в хорошем качестве

Low Back Pain: Simple or Complicated? Understanding the Key Differences

Join this channel to support the channel.    / @nabilebraheim   Low back pain can be classified as either simple or complicated. While it may seem that any form of pain is complex, low back pain can often be straightforward to diagnose and manage. Understanding the distinction between simple and complicated cases is crucial. Approximately 80% of the population will experience low back pain at some point in their lives, while about 3% will develop lower extremity radiculopathy. Radiculopathy presents as shooting pain radiating down the buttock, posterior thigh, and leg. When evaluating a patient with low back pain, several key questions should be asked. The first question: "Do you have bladder or bowel symptoms?" If the answer is no, that is reassuring. However, if the answer is yes, this could indicate cauda equina syndrome, a serious condition requiring emergency MRI to check for compression of the cauda equina. If compression is present, urgent surgery is necessary to prevent permanent bladder dysfunction. The second question: "Do you have an unsteady gait?" If the patient reports instability while walking and clumsiness in the hands, consider evaluating the cervical spine for possible cervical myelopathy, as another lesion may be contributing to their symptoms. The third question: "Does the pain radiate down your leg?" If the answer is yes, this suggests radiculopathy, a nerve irritation typically associated with lumbar disc herniation. Radicular pain follows a dermatomal pattern and is usually unilateral. For patients with low back pain alone, 50% will see improvement within one week, and 95% will recover within three months. However, for patients with radiculopathy, 50% improve within a month, while 75% recover within a year. Nerve irritation and radiculopathy take longer to heal compared to isolated low back pain. Neurogenic claudication should also be assessed. This condition presents as buttock and leg pain worsened by prolonged standing, often indicative of spinal stenosis. Hyperextension of the spine exacerbates the pain, while flexion relieves symptoms. Another important question: "Does your pain worsen with movement?" If the answer is yes, this suggests mechanical pain, which is preferable to pain that occurs at rest or at night, particularly when accompanied by weight loss or fever, as these symptoms may indicate a tumor or infection. Low back pain is a common reason for physician visits, accounting for 15% of new consultations. In 85% of cases, no specific cause is found, making diagnosis challenging. However, most cases are idiopathic and resolve within three months, which is a positive outcome. Another key distinction to make is whether the patient has more leg pain than back pain. If the leg pain is greater, the patient likely has sciatica (lumbar radiculopathy), often caused by a large or extruded disc herniation. If the back pain is more prominent than leg pain, conservative treatment is generally effective. Sciatica can often be self-diagnosed by patients, as it involves nerve root irritation typically due to herniated discs. The pain worsens with sitting, coughing, sneezing, and forward flexion, while lying down and resting relieve symptoms. If lumbar flexion is painful, it suggests a disc problem. If lumbar extension is painful, it suggests a facet joint problem. During physical examination, the straight leg raise test can help diagnose disc herniation with nerve root compression. Disc herniation with radicular pain is generally more complex than simple low back pain. Certain risk factors for low back pain include age (30-50 years), male gender, heavy lifting, twisting, job dissatisfaction, depression, exposure to excessive vibration, smoking, obesity, and a sedentary lifestyle. Occupational factors such as repetitive lifting and prolonged driving contribute to increased risk and should be modified to prevent pain. Disc pressure varies with position: The lowest pressure occurs while lying supine, followed by standing, while the highest pressure is observed when sitting and leaning forward. Imaging is usually not required within the first six weeks unless red flags are present (e.g., infection, tumor, or trauma). If imaging is necessary, X-ray should be performed first, as MRI can often reveal incidental findings that may not correlate with symptoms. Degenerative discs on MRI appear dark on T2-weighted images due to water loss, but these findings do not necessarily indicate pain, as many asymptomatic individuals have abnormal MRI results. MRI findings should be interpreted cautiously, as 35% of asymptomatic individuals under 40 years old have disc abnormalities, and this increases to 90% in those over 60 years old. If MRI is contraindicated (e.g., in patients with pacemakers), CT myelogram can be an alternative. CLICK ON THE LINK TO READ THE ARTICLE   / 622c4beaca41