Friday, May 4, 2012

Low back pain; indications for imaging

Do imaging (initial: X ray, most accurate :MRI) if  there's:

point tenderness + compression symptoms


IV drug use (risk of epidural abscess) + compression symptoms


History of cancer with suspected metastases  + compression symptoms


Sciatica (disc herniation) + compression symptoms


Cauda Equina syndrome


Ankylosing spondylitis: (fused vertebrae)
young man with stiffness & low back pain worsened by rest! + Archilles tendon pain, AV block, Aortic insufficiency, uveitis, arthritis in other jts
(do Xray sacroiliac jt as initial test)




Cauda Equina syndrome is xterised by:
  • Saddle anaesthesia
  • Loss of sphincteric tone
  • Incontinence
  • leg weakness
  • erectile dysfunction

Compression symptoms include:
  • focal neurological deficit
  • sensory loss
  • hyperreflexia
(if suspected, give steroids immediately before investigation)

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