Monday, November 30, 2009

Baby Got Back

On a single clinic afternoon, you get four patients with low back pain.

Challenge 1: A 45 year old has sharp or burning pain radiating down the lateral or posterior aspect of the leg to the ankle. There's a little bit of numbness and tingling. What's the diagnosis?

Challenge 2: A 70 year old man presents with urinary retention with overflow incontinence, bilateral shooting pain down the back of his legs, and leg weakness. You note perianal anesthesia. What's the diagnosis?

Challenge 3: A 16 year old IV drug user presents with low back pain after a day of heavy lifting. He has no other symptoms and no other medical problems. Do you image his back?

Challenge 4: A 30 year old woman who is a smoker presents with low back pain after sleeping funny for a week. She has no other symptoms and no other medical problems. Do you image her back?


Suheil said...

Challenge 1: IVDP
Challenge 2: Malignant compression of spinal cord due to mets from a prostate
Challenge 3: Image back to look for a Pott's spine?
Challenge 4: Do not image back?

Craig Chen said...

yep, good job!
Baby Got Back

Low back pain is the second most common outpatient chief complaint; the vast majority of patients will have a mechanical etiology rather than a neoplasm, infection, or inflammatory cause. Challenge 1 is sciatica, possibly from disc herniation; challenge 2 is cauda equina syndrome, a medical emergency, likely from metastatic prostate cancer; imaging is indicated in challenge 3 but not challenge 4. Indications for imaging include progressive neurologic findings, constitutional symptoms, traumatic onset, history of malignancy, age <18 or age >50, infectious risk, and osteoporosis.

Source: UpToDate.