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Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
Low Back Pain
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Low Back Pain

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Low Back Pain

Low Back Pain

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  • 1. Low Back Pain Dr Liau Kai Ming Dept. of Orthopaedic
  • 2. Incidence  Very common among working group  90% in pt >45years old  80% resolves with conservative treatment (in <3 months)  Only 5-10% may require operation
  • 3. Implication  Work & productivity loss
  • 4. Anatomical consideration  Commonly at lumbosacral junction (L4/L5, L5/S1)  Why?
  • 5.  Most mobile region of the spine  Therefore prone to degeneration (wear & tear)
  • 6. Causes of pain  Degenerative (most common)  Instability(fracture, spondylolisthesis)  Organic (Tumour,infection)  Nerve compression/irritation(PID, root compression)  Rule out psychogenic cause (insurance claim, problem with employer etc)
  • 7. Referred pain 1. Abdominal cavity gastritis/peptic ulcer pancreatitis cholecystitis 2. Urinary system renal calculi UTI 3. Pelvic cavity ovarian cyst dysmenorrhea 4. Aorta Aortic aneurysm
  • 8. Nature of pain  MECHANICAL VS NON-MECHANICAL  REFERRED VS RADICULAR  CLAUDICATION – VASCULAR VS SPINAL
  • 9. MECHANICAL PAIN 1. Muscle strain 2. Ligament sprain 3. Facet joint arthritis 4. Disc-Discogenic 5. Instability - Spondylolysis/spondylolisthesis
  • 10. NON-MECHANICAL PAIN  Infection – PYOGENIC VS TB  Tumour – PRIMARY VS SECONDARY  Primary - BENIGN VS MALIGNANT
  • 11. Common causes of low back pain Pathology Age Pain nature Assoc pain Assoc sx DEGENERA >40y mechanical Distance Active pt TIVE claudication Spondylosis Spondylolisth <20y mechanical extension Hyperextensi esis >40y on activity Trauma Any age mechanical - Trauma Infection Any age non- Rest pain Fever mechanical Mets >50y Non- Rest pain Primary + mechanical LOW LOA Osteoporosis >60y mechanical - Trivial trauma
  • 12. RED FLAGS  Constitutional symptoms  LOW, LOA, fever  AGE(>50)  IMMUNOCOMPROMISED,  TB CONTACT  KNOWN CANCER  NEUROLOGICAL DEFICIT (CAUDA EQUINA SYN)
  • 13. Physical findings  General examination  Age  Ill looking  Local examination – DO NOT MISS A GIBBUS
  • 14.  Deformity  Scoliosis/kyphosis  Step deformity  Local tenderness/paraspinal spasm  Limited ROM
  • 15.  Full neurological examination  ANAL TONE / PERIANAL SENSATION  DERMATOME & MYOTOME
  • 16. Investigations
  • 17. Plain radiograph  AP -loss of lumbar lordosis -reduced disc space -osteophytes -deformity -fracture (increase interpedicular distance) -osteoporosis -pedicle disruption
  • 18.  Lateral -fracture/wedging -kyphosis -spondylolisthesis  Oblique -spondylolysis (SCOTTIE DOG)
  • 19. Plain x-rays
  • 20. Blood investigations  FBC  Anemia, TWC  ESR  Liver function test  ALP  Renal function test  Calcium level
  • 21. CT Scan  better visualization of bone pathology (eg. cortical destruction)  fracture  tumor
  • 22. MRI  -better soft tissue visualization  -disc  -ligaments (ALL,PLL)  -nerves (spinal cord, roots)  -bone marrow  -pus collection
  • 23. MRI
  • 24. CT myelogram  role replaced by MRI  for delineation of neural structures where MRI is not available/contraindicated
  • 25. CT Myelogram
  • 26. Bone scan  Suspicious of multiple bone mets  Eg. with history of untreated/treated CA  Negative in Multiple myeloma
  • 27. Treatment  Mainly conservative -Bed rest/pelvic traction -physiotherapy -back exercise -modification of daily activities -SWD/ultrasound -NSAIDs/COX-2 inhibitor -local injection (epidural steroids, facet joint)
  • 28. Pelvic traction
  • 29. Surgery
  • 30. Indications for surgery -PAIN - failed conservative treatment (>6 months) -Evidence of neurological deficit (motor) -Cauda equina syndrome -Spinal instability (excessive spinal motion) -Unacceptable deformity (eg degenerative scoliosis)
  • 31. Surgery 1. DECOMPRESSION of spinal nerves (BURST FRACTURE, Spinal stenosis, PID) 2. Fusion & Stabilization (Instrumentation) 3. Correction of deformity
  • 32. DECOMPRESSION Surgery
  • 33. FUSION Surgery
  • 34. THANK YOU

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