Summary LOW BACK PAIN DIFFERENTIAL DIAGNOSIS

LOW BACK PAIN DIFFERENTIAL DIAGNOSIS : rauma 1) Lumbar strain -postural or occupational 2) Compression fracture 3) Subluxation of the facet joint 4) Disc prolapse/Disc herniation with nerve root compression B.Arthritic conditions 1) Spondylosis 2) Spondylolisthesis 3) Ankylosing spondylitis 4) Rheumatoid arthritis 5) Hypertrophic arthritis C. Infections 1) Acute bacterial disc space infection 2) Tuber culous If a patient presents with pain at rest or at night, this is generally not mechanical back pain. One must consider either an infectious process such as an epidural abscess, or spinal osteomyelitis. In addition, neoplastic disease must be considered. Simil arly, if a patient seems to be writhing in pain rather than lying still, this picture suggests a visceral aetiology such as renal calculi or an intra-abdominal process. Abdominal palpation of a pulsatile mass should alert one to the possibility of an aortic aneurysm. spondylitis 3) Vertebral osteomyelitis, discitis 4) Sacroiliac joint infection D.Metabolic diseases 1) Osteoporosis 2) Sickle cell disease 3) Pagets disease 4) Onchronosis E.Tumours Benign 1) Meningioma or neurinoma 2) Osteoid osteoma 3) Osteoblastoma Malignant 1) Metastasis cancer (breast, lung, prostate) 2) Primary neural tumors 3) Myelogenous diseases -Multiple myelom,Hodgkins disease, Eosinophilic granuloma F. Mechanical problems Spinal stenosis Non-skeletal disorders If the patient has frank neurological deficit and symptoms of Urinary retention or incontinence one must consider the possibility of a space -occupying lesion within the canal, such as a herniated disc, an epidural abscess, or a neoplasm. LUMBA R DISK HERNIATION Symptomatic disk herniations are seen in all age groups but have their peak in patients between 35 and 45 years of age. While smoking is a general risk factor for disk degeneration and herniation ccupational risk factors include sedentar y work and motor vehicle driving. Sciatica, characterized by pain radiating down the leg in a dermatomal distribution, is the most