Low back pain/Swelling

Low back pain/Swelling
Herniated lumbar disc. A frequent cause of low back pain. Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

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Low back pain is the most common cause of disability in the United States.

Epidemiology and Demographics

• 90% of the population of the United States will experience low back pain at some point in their lives
• At any given time, up to 20% of the population is experiencing lower back pain, as studies have shown

Differential diagnosis of causes of low back pain

In alphabetical order.

• Abdominal aneurysm
• Abscess
• Cancer
• Cauda equina syndrome
• Extraspinal causes
• Inflammation
• Lumbar disc herniation
• Lumbosacral muscle strain
• Osteomyelitis
• Paget's disease
• Sacral-iliac joint dysfunction
• Secondary gain
• Spinal stenosis
• Spondylolisthesis
• Trauma or strain to the back muscles
• Vertebral fracture

Diagnosis

• Various imaging techniques and lab studies are necessary if crucial indicators are present (fractures, tumor, infection, cauda equina syndrome)
• No imaging or labs are required if indicators are not apparent (unless pain persists)

Physical Examination

• Range of motion
• Strength
• Sensation
• Reflexes
• Straight leg raise test
• Neurovascular status

MRI and CT

• MRI is the most useful diagnostic tool

Treatment

• Return to activity as soon as possible (if indicators are absent)
• Patient education
• Physical therapy

Acute Pharmacotherapies

• Acetaminophen
• Opioids
• Nonsteriodal anti-inflammatory drugs (NSAIDs)
• Muscle relaxants
• Epidural corticosteroid injections

Surgery and Device Based Therapy

• Surgery may be indicated

Acknowledgements

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