Approach to low backache Dr aniket wankhede
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Approach to low backache Dr aniket wankhede
- 1. APPROACH TO LOW BACKACHE Dr. C M BADOLE PROFESSOR AND HEAD OF DEPARTMENT OF ORTHOPAEDICS MGIMS, SEVAGRAM.
- 2. INTRODUCTION
- 3. Anatomy
- 8. HISTORY ◦ Onset ◦ Character ◦ Location and radiation. ◦ Motor sensory symptoms ,history of bladder and bowel involvement ◦ Duration of pain - < 6 wks acute, 6-12 week subacute, >12 week – chronic ◦ Intensity ◦ Associated symptoms ◦ Aggravating factors ◦ Relieving factors
- 9. Associated symptoms ◦ Stiffness ◦ Pain in other joints – rheumatic diseases ◦ Neurlogical symptoms- parasthesia ,numbness or weakness may point to the lesion of the nervous tissue ◦ Extra skeletal symptoms ◦ Mental status
- 10. CAUSES ◦ Congenital Spina bifida Spondylolisthesis Hemivertebrae Split vertebrae Abnormalities in the articular processes Sacralization of L5 vertebrae ◦ Traumatic Lumbosacral sprain : muscles and ligaments ◦ Traumatic spondylolisthesis Trauma to intervertebral disc Compression fracture Fracture of spinous processes or the transverse processes Ruptured intervertebral disc ◦ Postural imbalance AP imbalance Pregnancy Pot belly kyphosis Backache in computer users Lateral imbalance Scoliosis Discrepancy in length of both legs
- 14. ◦ Inflammatory Pyogenic Tuberculosis Brucellosis Rheumatoid arthritis Ankylosing spondylitis Myositis ◦ Degenerative Spondylitis Osteoporosis in the elderly Prolapsed I V disc Neoplastic Primary – Multiple myeloma Haemnagioma Eosinophilic granuloma Aneurismal bone cyst Osteoma Secondary- Breast Bronchus Kidney Suprarenal Prostrate METABOLIC CAUSES Osteoporosis
- 15. Other than back causes Abdominal diseases Pancreatitis Cholecystitis Peptic ulcer Hiatus hernia Pelvic diseases Inflammation of ovaries anf fallopian tubes Intraplevic tumor Renal causes Renal infection Ureteric calculus Vascular causes Ischaemic pain from occlusion of the aorta or iliac arteries Miscellaneous Exposure to cold Viral infection Fibrosis Myositis Chronic constipation Febril illness Depressive psychosis
- 19. Backache In elderly Causes : Lumbar spondylosis Osteoporosis Secondaries especially from prostrate Psychogenic depression
- 20. Physical examination ◦ Standing position Position Spasm – more in acute back pain Tenderness – may indicate ligament and muscle tear Range of motion – spinal mobility from the hip to be differentiated. ◦ Lying down position straight leg test Neurological examination Peripheral pulsations adjacent joints to be examined Abdominal examination Rectal and pervagina examination
- 21. Investigations ◦ Diagnosis of backpain is essentially clinical but some tests may aid us in guiding towards the diagnosis. 1 ct 2 mri whole spine 3 blood investigations 4 electromyography 5 bone scan
- 25. Differential diagnosis ◦ Pain worsens on sitting and improves by walking or standing up facet joint disease ◦ Pain worsens on walking or standing and on coughing sneezing or straining Prolapsed intervertebral disc ◦ Pain worsens on walking gets relieved y rest and then again worsens on walking Intermittent walking neurogenic claudication ◦ Patient is writhing in pain rather than lying still Visceral pathology must be ruled out ◦ Pain loacalized to lower back associated with bony tenderness Tuberculosis and secondaries
- 26. Treatment (conservative- acute and chronic) ◦ Rest ◦ Drugs ◦ Physiotherapy ◦ Traction ◦ Use of corset ◦ Education ◦ If conservative fails then surgical
- 28. Indications of surgery ◦ Intractable leg pain or radiation in the leg ◦ Progressive neurological deficits ◦ Cauda equina syndrome ◦ Bladder/bowel involvement ◦ Loss of perianal sensation
- 29. Fear
- 30. Various surgical treatments Open surgical techniques ◦ Laminectomy / disscectomy ◦ Laminotomy ◦ Hemilaminectomy ◦ Fenestration minimally invasive technique ◦ Microscopic discectomy ◦ Microendoscopic discectomy Percuatneous
- 32. others ◦ Disc replacement surgery ◦ Vertebroplasty ◦ Bone fusion technique
- 34. Spinal surgery and medical negligence
- 35. Prevention