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Sherif Elwatidy MD, FRCS(SN)
Professor of NeurosurgeryCollege of Medicine, KSU
BACK PAIN
HOW DO YOU MAINTAIN A HEALTHY BACK
(AVOIDANCE OF BACK PAIN)
How many of you had back
pain ?
Epidemiology
60 – 90% of adults experience back pain at
some point in their life.
- incidence age 35- 55 y.o.
- 90% resolve in 6 weeks
- 7% become chronic
- M/ F equally affected
Most episodes of LBP are self limited
85% never given precise pathoanatomical diagn.
Low Back Pain (FACTS)
Second most common cause of
missed work days
Leading cause of disability between
ages of 19-45
Number one impairment in
occupational injuries
Healthcare expenditures $90
Billion (1998) , $26.3 Billion
attributable to back pain
How do you know your back is
Healthy ?
Anatomy (origin of Back pain)
Common Pathoanatomical Conditions of the Lumbar Spine
Disc Degeneration – PathoPhysiology
With age and repeated
efforts, the lower lumbar
discs lose their height
and water content (“bone
on bone”)
Abnormal motion
between the bones leads
to pain
Pathogenesis of Deg. Spondylosis
Factors accelerating spinal Degeneration
Genetic
Smoking
Occupational factors include:
- accident‐related trauma
- heavy physical loading and materials
handling
- lifting, bending, and twisting; prolonged
sitting;
- sustained non-neutral work postures and
vehicular
driving
Overweight
Lack of exercises
Plan ahead, don’t hurry
Spread feet shoulder distance apart
Bend knees
Lift with leg muscles
Tighten stomach muscles
Move in close when
placing object on high shelf
Don’t twist
14
Take Healthy Postures
What Does The Research Show?
% Load Compression On L3 During the Upright Standing, Lying Down, and Sitting.
Compression Increases More with Spinal Flexion, and Increases Still Further with a Slouched Sitting Position.
Differential Diagnosis of Low Back Pain
Diagnoses we don’t want to
miss
Tumor (of bone or viscera)
Infection
Fracture
Any process resulting in severe compromise of
nervous tissue
Systemic illnesses affecting joints
Leaking abdominal aortic aneurysm
History: the nine red pain
flags
Prominent neurological symptoms of weakness, numbness, loss of bowel or bladder control, difficulty walking
Pain is much worse at night
Fever
Other constitutional symptoms that always worry us
Patient cannot sit or stand due to pain
Pain following a fall in the elderly or in a patient at risk for osteoporosis
Leg pain is much worse than back pain
History of cancer in the last five years, particularly breast, lung, prostate,thyroid, renal
Polyarthralgias
Historical aspects that increased
suspicion for infection
Recent IV drug abuse
Immunosuppression
Diabetes
Things we don't want to miss in physical
exam
Neurological signs such as:
loss of reflex in the area of pain
profound focal weakness
profound diffuse proximal weakness
upgoing Plantars
clonus at the ankle
hyperreflexia
Loss of sphincter tone
Things we don’t want to miss
physical exam 2
The patient can’t walk or sit due to back or leg pain.
Severe pain with movement when it has lasted for more than one week history
Severe muscle spasm when it has lasted more than one week on history
Extreme and localized tenderness to percussion over the spinous processes or other bony prominences
Joint effusions, redness, synovial bogginess, tenderness
Predominantly back pain
1. Discogenic pain (annular tear)
2. Painful osteoarthritis of the facet joints
3. Structural pathology
(Congenital or degenerative kyphosis/scoliosis)
4. Compression fracture
5. Spondylolysis/spondylolisthesis
6. Inflammatory spondylitis
7. Visceral pathology
Predominantly leg pain
1. Herniated nucleus pulposus
2. Spinal stenosis
Less common “benign” causes of chronic back and leg pain
Sacroiliac joint pain
Coccydynia
Polymyalgia rheumatica
Stiff man syndrome
Multiple sclerosis
Parkinson’s disease
Sciatic nerve entrapment
Post viral and other autoimmune radiculitis/plexitis
Benign Mechanical Back pain
Usually worse in the morning then improves
with activity, varies with posture/activity
Usually lower lumbar pain, also buttocks and
thighs
Dull poorly localised pain
Cause cannot be attributed to any specific
pathology.
Nerve root pain
Due to nerve root irritation eg from a prolapsed
disc
Shooting pain and paraesthesia down back of
thigh sometimes as far as the heel.
May also affect anterolateral thigh if femoral
nerve roots are affected.
Cauda Equina
Syndrome
Bladder dysfunction, usually retention.
Sphincter disturbance
Saddle anaesthesia
Lower limb weakness
Gait disturbance
Urgent referral is mandatory
Take Home Message
Stop Smoking
Healthy habits of sitting , bending, lifting, driving
Reduce weight
Exercises / walking
Healthy Food rich in (Vit. C, Vit. E, Mg)