0071643192.pdf

ORTHOPEDICS

■ Epidural abscess

■ Aortic aneurysm

■ Kidney stone/infection

■ Cancer

■ Fracture

■ Spinal stenosis

DIAGNOSIS

■ History and exam are critical!

■ Lumbosacral X-rays are generally overused but should be considered if

■ Patient’s age > 55

■ Trauma with vertebral tenderness

■ Pain lasting longer than 1 month

■ History of IDU

■ Suspicion for cancer or infection such as fever or weight loss

■ CT scan and MRI are more sensitive for infection and cancer.

■ MRI better for herniated discs and neurological impairment

TREATMENT

■ Treat underlying cause.

■ If musculoskeletal in origin:

■ Ice in first 24–72 hours; afterward, heat may be helpful.

■ Pain medication

■ Muscle relaxants

■ Activity as tolerated: Neither complete bedrest nor active physical

therapy that causes pain is helpful.

■ Neurosurgical or spine specialist consultation if any neurological impairment

COMPLICATIONS

Chronic pain, neurological impairment, disability, opiate addiction

Cauda Equina Syndrome

Usually stems from a herniated disc that protrudes midline and compresses the

nerve roots of the cauda equine; can also be caused by tumor and infection

SYMPTOMS

■ Back pain

■ Leg weakness

■ Numbness

■ Bladder and/or bowel retention (followed by incontinence)

EXAM

■ Loss of sensation in the “saddle distribution”

■ Loss of rectal tone

■ Loss of bulbocavernosus reflex

■ Loss of deep tendon reflexes

■ Distended bladder

DIAGNOSIS

■ Clinical suspicion

■ MRI or CT myelogram