DD:backpain1

Template:Backpain1 the differential diagnosis of acute onset lower back pain, with bowel and bladder dysfunction, sensory and motor deficits,

Classification of pain in the back based on etiology	Diease	Clinical Manifestation																	Diagnosis		Comments
		Symptoms											Signs						Lab findings	Imaging
		Onset	Duration	Quality of pain	Radiation	Stiffness	Fever	Rigors and chills	Headache	Nausea and vomiting	Syncopy	Weight loss	Motor weakness	Sensory deficit	Pulse Deficit	Heart Murmur	Bowel or bladder dysfunction	Horner's syndrome	Lab findings	Imaging
Neurological	Arachnoiditis^[1]	Acute	Hours	Dull aching pain	Head, neck and back	+/-	+	+/-	+/-	+/-	+/-	+/-	+/-	+/-	-	-	+/-	+/-	CSF Elevated protein with normal or low glucose Culture and sensitivity May be due to TB or Meningitis Nucleic acid tests Helpful in tuberculous meningitis	Radiography Thickened nerve roots CT Narrowing of subarachnoid space Irregular collections of contrast material Thickened nerve roots MRI Study of choice shows indistinct cord outline	Usually caused by meningitis or TB
	Cauda equina syndrome^[2]^[3]	Acute	Hours	Severe, sharp local pain	Rarely to sacroiliac joint	-	-	-	-	-	-	-	+	+/-	-	-	+/-	-	CBC To rule out anemia Electrolytes, blood urea nitrogen, and creatinine To rule out renal failure and retroperitoneal hematoma Erythrocyte sedimentation rate To rule out inflammatory origin Syphilis serology To rule out meningovascular syphilis	Radiography May show vertebral erosions MRI Of choice and may show nerve root abnormalities Duplex For vascular abnormalities Lumbar puncture For inflammation	Electrical studies: EMG Done to rule out acute denervation SSEPs Done to rule out multiple sclerosis
	Epidural abscess^[4]^[5]	Acute	Variable	Dull, throbbing pain	Locally	-	+/-	+/-	+/-	+/-	+/-	+/-	+/-	+/-	-	-	+/-	+/-	CBC May show leukocytosis, left shift, thrombocytopenia, and anemia ESR Elevated Culture and sensitivity To identify causative organism Immunohistochemical staining Includes gram stain, special stains for fungi and mycobacteria, also consider brucella	MRI Of choice and demonstrates fluid collection CT Demonstrates fluid collection Radiography Demonstrates osteomyelitis or vertebral collapse	LP carries risk of spread of infection
	Radiculopathy^[6]^[7]	Acute	Variable	Severe, shooting pain	Anterior thigh and knee	+/-	-	-	-	-	-	-	+/-	+/-	-	-	+/-	-	Typically no specific lab findings	Radiography To rule out serious underlying etiology CT Demonstrates disc herniation MRI Demonstrates disc herniation and nerve root impingement Myelography Used preoperatively to visualize spinal anatomy accurately Discography To localize a symptomatic disc	Disc herniation is the most common cause of nerve impingement
	Sciatica^[8]^[9]^[9]	Acute	Minutes to hours	Severe, shooting pain	Posterior thigh, buttocks and knee	+/-	-	-	-	-	-	-	+/-	+/-	-	-	+/-	-	To exclude other pathologies CBC with differential ESR Alkaline and acid phosphatase level Serum calcium level Serum protein electrophoresis	Radiography With technetium-99m labeled phosphorus to indicate bone mineralization status CT Demonstrates disc herniation MRI Demonstrates disc herniation and nerve root impingement Myelography Used preoperatively to visualize spinal anatomy accurately Discography To localize a symptomatic disc	May have a psychological component
	Spinal cord compression^[2]^[3] - Thoracic spine - Lumbar spine	Acute	Minutes to hours	Severe and localized	Locally, may radiate below lesion	-	-	-	-	-	-	-	+/-	+/-	-	-	+/-	-	Neoplasm must be suspected and is ruled out by CBC - May demonstrate a pancytopenia Prothrombin time and activated partial thromboplastin time - May be prolonged Metabolic profile, including calcium level and liver function - May indicate metastasis	MRI May demonstrate tumors and collapse of intervertebral spaces May distinguish between bone lesions and malignancy Radiography May demonstrates bony destruction or calcification Nuclear imaging To identify neoplasms	Aggressive radiotherapy is often needed

↑ Ozateş M, Kemaloglu S, Gürkan F, Ozkan U, Hoşoglu S, Simşek MM (January 2000). "CT of the brain in tuberculous meningitis. A review of 289 patients". Acta Radiol. 41 (1): 13–7. PMID 10665863.
↑ ^2.0 ^2.1 Bach F, Larsen BH, Rohde K, Børgesen SE, Gjerris F, Bøge-Rasmussen T, Agerlin N, Rasmusson B, Stjernholm P, Sørensen PS (1990). "Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression". Acta Neurochir (Wien). 107 (1–2): 37–43. PMID 2096606.
↑ ^3.0 ^3.1 Helweg-Larsen S, Sørensen PS (1994). "Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients". Eur. J. Cancer. 30A (3): 396–8. PMID 8204366.
↑ Nathoo N, Nadvi SS, van Dellen JR (April 1999). "Cranial extradural empyema in the era of computed tomography: a review of 82 cases". Neurosurgery. 44 (4): 748–53, discussion 753–4. PMID 10201299.
↑ Heran NS, Steinbok P, Cochrane DD (October 2003). "Conservative neurosurgical management of intracranial epidural abscesses in children". Neurosurgery. 53 (4): 893–7, discussion 897–8. PMID 14519222.
↑ Bischoff RJ, Rodriguez RP, Gupta K, Righi A, Dalton JE, Whitecloud TS (August 1993). "A comparison of computed tomography-myelography, magnetic resonance imaging, and myelography in the diagnosis of herniated nucleus pulposus and spinal stenosis". J Spinal Disord. 6 (4): 289–95. PMID 8219542.
↑ Tarulli AW, Raynor EM (May 2007). "Lumbosacral radiculopathy". Neurol Clin. 25 (2): 387–405. doi:10.1016/j.ncl.2007.01.008.
↑ Hay MC (June 1976). "Anatomy of the lumbar spine". Med. J. Aust. 1 (23): 874–6. PMID 967084.
↑ ^9.0 ^9.1 Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA (February 1999). "Lack of effectiveness of bed rest for sciatica". N. Engl. J. Med. 340 (6): 418–23. doi:10.1056/NEJM199902113400602. PMID 9971865.

[pmid10665863-1] Ozateş M, Kemaloglu S, Gürkan F, Ozkan U, Hoşoglu S, Simşek MM (January 2000). "CT of the brain in tuberculous meningitis. A review of 289 patients". Acta Radiol. 41 (1): 13–7. PMID 10665863.

[pmid2096606-2] 2.0 ^2.1 Bach F, Larsen BH, Rohde K, Børgesen SE, Gjerris F, Bøge-Rasmussen T, Agerlin N, Rasmusson B, Stjernholm P, Sørensen PS (1990). "Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression". Acta Neurochir (Wien). 107 (1–2): 37–43. PMID 2096606.

[pmid8204366-3] 3.0 ^3.1 Helweg-Larsen S, Sørensen PS (1994). "Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients". Eur. J. Cancer. 30A (3): 396–8. PMID 8204366.

[pmid10201299-4] Nathoo N, Nadvi SS, van Dellen JR (April 1999). "Cranial extradural empyema in the era of computed tomography: a review of 82 cases". Neurosurgery. 44 (4): 748–53, discussion 753–4. PMID 10201299.

[pmid14519222-5] Heran NS, Steinbok P, Cochrane DD (October 2003). "Conservative neurosurgical management of intracranial epidural abscesses in children". Neurosurgery. 53 (4): 893–7, discussion 897–8. PMID 14519222.

[pmid8219542-6] Bischoff RJ, Rodriguez RP, Gupta K, Righi A, Dalton JE, Whitecloud TS (August 1993). "A comparison of computed tomography-myelography, magnetic resonance imaging, and myelography in the diagnosis of herniated nucleus pulposus and spinal stenosis". J Spinal Disord. 6 (4): 289–95. PMID 8219542.

[pmid-7] Tarulli AW, Raynor EM (May 2007). "Lumbosacral radiculopathy". Neurol Clin. 25 (2): 387–405. doi:10.1016/j.ncl.2007.01.008.

[pmid967084-8] Hay MC (June 1976). "Anatomy of the lumbar spine". Med. J. Aust. 1 (23): 874–6. PMID 967084.

[pmid9971865-9] 9.0 ^9.1 Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA (February 1999). "Lack of effectiveness of bed rest for sciatica". N. Engl. J. Med. 340 (6): 418–23. doi:10.1056/NEJM199902113400602. PMID 9971865.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

DD:backpain1

Navigation menu