5 Diagnostic Triage For Back Pain

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he main diagnostic indicators for simple backache,nerve root pain and possible serious spinal pathology are outline below:

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     1. Simple backache:-

  • Onset generally age 20-55 years.
  • Lumbosacral region,buttocks and thigh.
  • Pain mechanical in nature

          -varies with physical activity

          -Varies with time

  • Patient well
  • Prognosis good (90% recover from acute attack in 6 weeks)

    2. Nerve root pain:-

  • Unilateral leg pain>back pain
  • Pain generally radiates to foot or toes
  • Numbness and paraesthesia in the same distribution
  • Nerve irritation signs

        – reduced straight leg raising which reproduces leg pain

  • Motor,sensory or reflex change

        – limited to one nerve root

  • Prognosis reasonable

        – (50% recover from acute attack within 6 weeks)

    3. Possible serious spinal pathology

  • Age of onset<20 or>55 years
  • Violent trauma: r.g.fall from a height,road traffic accident
  • Constant,progressive , non-mechanical pain
  • Thoracic pain
  • PMH-carcinoma
  • Systemic steroids
  • Drug abuse,HIV
  • Systemically unwell
  • Weight loss
  • Persisting severe restriction of lumber flexion
  • Widespread neurology
  • Structural deformity

  4. Cauda equina syndrome/widespread neurological   disorder

  • Difficulty with micturition
  • Loss of anal sphincter tone or faucal incontinence

         If there are suspicious clinical features,or if pain has not settled in 6 weeks,an ESR and plan X-ray should be considered.

  • Saddle anesthesia about the anus,perineum or genitals
  • Widespread (>one nerve root)or progressive motor weakness in the legs or gait disturbance.

  5. Inflammatory disorder (ankylosing spondylitis and related disorders)

  • Gradual onset
  • Marked morning stiffness
  • Persisting limitation of spinal movements in all direction
  • Peripheral joint involvement
  • Iritic,skin rashes (psoriasis),colitis,urethral discharge
  • Family history

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