This document discusses various cases of acute low back pain and differential diagnoses. It describes 25 and 45 year old men who developed acute low back pain after lifting objects. Red flags for more serious underlying causes are described, including nocturnal pain, pain at rest, and neurological deficits. Conditions that can mimic back pain are outlined, such as pregnancy, infections, abdominal issues, and inflammatory diseases. Specific cases of conditions like pancreatitis, aneurysm, ankylosing spondylitis, and depression are also mentioned. The document provides guidance on evaluating for more serious potential causes of back pain like fractures, tumors, and epidural metastases.

1. Acute Low Back Pain
with a normal X-ray
Spiro Antoniades, M.D.
Upper Chesapeake Health Spine Center
10/2/15

2. 25 yo man acute LBP
After lifting a dresser up
Steps, stiff painful cannot
Put on his sox no sciatica

4. 45 yo man acute LBP
After picking up a pencil
With h/o mild LBP for 20 y

5. Red flag
 Nocturnal pain
 Pain at rest improves with activity
 Progressive neurological deficit
 Suspicious for cancer or infection

8. High index of suspicion
 H/O cancer
 Osteoporosis/steroids/immunosuppression
 AS
 10/10
 Weight loss
 IVDA
 UTI/sepsis

9. Cauda Equina Syndrome

13. Differential Diagnosis Back Pain
Not from the Spine
 Pregnancy
 Pregnancy with Labor
 Menstrual Period
 UTI
 Abdomen (cholecystitis, pancreatitis, aortic
aneurysm, peptic ulcer disease, nephrolithiasis,
pelvic inflammatory disease, diverticulitis)
 Inflammatory Arthropathy: Ankylosing
Spondylitis, Lymes
 SI joint: infection, AS, hyperparathyroidism
 Depression

16. Pancreatitis

17. Labor
Pregnancy
Menstrual period

21. AAA

27. AS

28. Sacroiliitis
 30 year old man with LBP HLAB27+

30. Synovitis, subchondral edema, iliac side more common

32. Brown tumor

34. Psychosocial Issues
 Fear
 Anxiety
 Financial problems
 Anger
 Depression
 Job dissatisfaction
 Family problems
 Stress

35. DSM-IV TR criteria for Major
Depressive Episode (5 Sx for at
least 2 weeks)
 1. Depressed mood
 Markedly diminished interest or pleasure in all or
almost all activities
 >5% weight loss or gain, change in apetite
 Insomnia or hyper somnia
 Psychomotor agitation or retardation
 Fatigue or loss of energy
 Feeling of worthlessness or inappropriate guilt
 Diminished concentration or indecisiveness
 Recurrent thoughts of death or suicide

37. 66 wf LBP urosepsis(E Coli blood and urine) claustrophobia

41. Occult Fracture
75 wm severe! LBP S/P cement 6 months ago
65 year old man with
Recurrent LBP that is
severe

44. Tumor: vertebral body
 Vertebral body met

45. Epidural metastasis

46. 48 year old woman severe LBP for six months despite swimming,
NSAID, PT, muscle relaxers, opiates, injections

48. 21 male severe! neck pain for three months with multiple ER
visits for narcotics/physical therapy visits/feels clumsy/ three
day history of difficulty walking following fall

51. Thanks!

52. 48 year old man with three week H/O severe neck pain with no improvement with
2 weeks of prednisone/narcotics/muscle relaxers

55. 75 year old man severe neck pain