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Approach to LBA.ppt
- 1. Low Back Pain -AnEasy Approach To a Difficult Problem Dr. Dipak Maharjan
- 2. • 80% ofthe population in their lifetime • The most common cause of disability OCNA J Carragee, M Hannibal
- 3. Natural History 60% recoverin 1 week M. Ritter JBJS Am. 87 2006
- 4. Purpose • Structures forLBA • History taking • Examination • Relevant Investigations • Management
- 5. Approach according toStructure • Skin • Muscles and Fascia • Bone/Spine • Intervertebral Disc • Spinal Cord and Nerve roots • Visceral Diseases
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- 13. Infections • Bacterial/ PyogenicInfections • Tuberculous Spondylitis • Fungal Infections
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- 18. Developmental High GradeListhesis
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- 20. L3 Primary BoneTumor
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- 28. Relevant History inLBA • Pain • Walking Distance • Weakness • Bowel and Bladder habits • Diabetes, Smoking, Family hx Malignancy
- 29. Pain – STARX2 • Site - Localized to lowback • Type – Sharp Shooting, tingling, numb • Associated Factors – Constituent symptoms of TB, Mg • Radiation – Back of thigh, Calf, upto ankle, toes • Severity – VAS • Time – Duration, Continuous • Aggravating Factors – Sneezing, walking, climbing down • Relieving Factors – rest, leaning forward
- 30. Walking Distance • Nopain on walking • Can walk a few kms. • Pain after walking a few steps
- 31. Neurology • Weakness –unsteady gait • Sensory deficits – numbness, can feel less • Bowel/ Bladder – unable to void, incontinence constipation sexual dysfunction
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- 33. INSPECTION • SKIN ANDSUBCUTANEOUS TISSUE • GAIT • LIST • DEFORMITY
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- 37. PALPATION • SPINAL TENDERNESS •PARASPINAL MUSCLE SPASM • STEP OFF DEFORMITY - Listhesis • SWELLING
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- 39. NEUROLOGIC EXAMINATION • MotorExamination • Sensory Examination • Reflexes • Per-rectal examination
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- 41. Motor Examination • L2:Hip Flexors • L3: Knee Extensors • L4: Ankle Dorsiflexors • L5: Toe Extensors • S1: Ankle Plantorflexors & Toe Flexors
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- 43. Examn …. Contd… •Reflex – Ankle Jerk S1 • Dorsalis Pedis Pulsation • Posterior Tibial Pulsation
- 44. Per – rectalExamination • Perianal Sensation – S3S4S5 • Anal Wink • Anal Tone • Voluntary Anal Contraction
- 45. Investigations • Complete BloodPicture • ESR, CRP • Liver Function test • Renal Function Test • RA factor, HLA B27, ANA • Bone Scan • CT guided/Open Biopsy, Tissue Culture
- 46. Investigations • X- rays, Dynamic views • CT scans • MRI
- 47. Tb/ Mg –L5 25/M
- 48. Tb/ Mg –L5
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- 51. Surgery IVDP Degenerative Spinal stenosis Spondylolisthesis Infectivespondilitis Tumours Trauma
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- 61. Developmental High GradeListhesis
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