Introduction
Pain in the back from the level of the lowest rib down to the gluteal fold, with or without radiation into the legs.
- M/C musculoskeletal condition affecting adults (84% prevalence)
- Leading cause of years lived with disability worldwide
- LBP is a symptom and not a disease
Classification
- By duration:
- Acute (< 6 weeks)
- Sub-chronic (6-12 weeks)
- Chronic LBP (CLBP) (> 12 weeks)
- By underlying cause:
- Mechanical
- Non-mechanical
- Referred pain
Aetiology
- Musculoskeletal:
- Mechanical (including muscle strain, muscle spasm, or osteoarthritis)
- Herniated nucleus pulposus, herniated disk
- Spinal stenosis
- Compression fracture
- Inflammatory:
- HLA-B27 associated arthritis including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and inflammatory bowel disease
- Malignancy:
- Bone metastasis from lung, breast, prostate, thyroid, among others
- Infectious:
Pathophysiology
Clinical features
Diagnosis
Red flags:
Red flag |
Possible cause |
Previous history of cancer |
Cancer |
Unintentional weight loss |
Loss of bladder/bowel control |
Cauda equina syndrome |
Significant motor/sensory loss |
Loss of sensation in buttocks (saddle anaesthesia) |
Significant trauma related to age |
Fracture |
Chronic corticosteroid use |
Osteoporosis |
Severe pain after lumbar surgery in past year |
Infection |
Fever |
Urinary tract infection |
Immunosuppression |
Intravenous drug use |
Imaging
CT scan:
MRI:
Management
Summary
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