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    Low Back Pain: Dr. Suherman, SP.S

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    rhezzaagxx
    The document discusses low back pain (LBP), classifying it as acute (<2-8 weeks), subacute (2-8 to 12 weeks), or chronic (>12 weeks). Common causes of LBP include mechanical issues, inflammation, degeneration, and psychological factors. Herniated discs are also discussed, including grades of herniation and associated clinical symptoms. Spinal stenosis and its most frequent causes such as degenerative changes are covered. Surgical treatment of spinal stenosis is indicated for persistent intolerable pain, limited mobility, or neurological deficits.

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    Low Back Pain: Dr. Suherman, SP.S

    Uploaded by

    rhezzaagxx
    28 views27 pages
    The document discusses low back pain (LBP), classifying it as acute (<2-8 weeks), subacute (2-8 to 12 weeks), or chronic (>12 weeks). Common causes of LBP include mechanical issues, inflammation, degeneration, and psychological factors. Herniated discs are also discussed, including grades of herniation and associated clinical symptoms. Spinal stenosis and its most frequent causes such as degenerative changes are covered. Surgical treatment of spinal stenosis is indicated for persistent intolerable pain, limited mobility, or neurological deficits.

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    LBP 2007

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    The document discusses low back pain (LBP), classifying it as acute (<2-8 weeks), subacute (2-8 to 12 weeks), or chronic (>12 weeks). Common causes of LBP include mechanical issues, inflammation, degeneration, and psychological factors. Herniated discs are also discussed, including grades of herniation and associated clinical symptoms. Spinal stenosis and its most frequent causes such as degenerative changes are covered. Surgical treatment of spinal stenosis is indicated for persistent intolerable pain, limited mobility, or neurological deficits.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    28 views27 pages

    Low Back Pain: Dr. Suherman, SP.S

    Uploaded by

    rhezzaagxx
    The document discusses low back pain (LBP), classifying it as acute (<2-8 weeks), subacute (2-8 to 12 weeks), or chronic (>12 weeks). Common causes of LBP include mechanical issues, inflammation, degeneration, and psychological factors. Herniated discs are also discussed, including grades of herniation and associated clinical symptoms. Spinal stenosis and its most frequent causes such as degenerative changes are covered. Surgical treatment of spinal stenosis is indicated for persistent intolerable pain, limited mobility, or neurological deficits.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 27

    LOW BACK PAIN

    Dr. SUHERMAN,SP.S

    CLASSIFICATION

    ACCORDING TO ITS DURATION, LBP IS DIVIDED INTO : ACUTE : < 2-8 WEEKS SUBACUTE : 2-8 WEEKS 12 WEEKS CHRONIC : > 12 WEEKS

    EPIDEMIOLOGY

    Life time prevalence 59% 10% leads to consultation to GP 90% improved in 1 month up to 70% patient tend to recur

    etiology

    Non-specific mechanical back pain Facet joint syndrome Lumbar disc degeneration (lumbar spondylosis) Lumbar disc prolapse Spondylolisthesis Spinal stenosis Osteoporosis Sero-negative spondyl arthritis (including ankylosing spondylitis) Vertebral infection Disc space infection Malignancy secondary myeloma and primary Pagets disease, referred-visceral, pancreatic/pelvic, etc

    RED FLAGS POSSIBLE SERIOUS SPINAL PATHOLOGY

    Age of onset : < 20 or 55 years Violent trauma, eg fall from a height, traffic accident Constant, progressive, non-mechanical pain Thoracic pain History of carcinoma Systemic steroids Drug abuse, HIV infection Systemically unwell Weight loss Persistent severe restriction of lumbar flexion Widespread neurological deficit Structural deformity

    COMMON ETIOLOGY

    1. 2. 3. 4. 5.

    Mechanical (deformity, trauma) Inflammation Neoplasm Degenerative Psychological

    PRIMARY MECHANICAL DEARRANGEMENT


    Ligamentous Strain Muscle strain or spasm Facet join disruption or degeneration Intervertebral disc degeneration or herniation Vertebral compression fracture Vertebral end-plate microfractures Spondylolisthesis Spinal stenosis Diffuse idiopathic skeletal hyperostosis

    THE DISTINCTION AMONG SPONDYLOSIS, SPONDYLOLISIS AND SPONDYLOLISTHESIS

    SPONDYLOSIS : refers to osteoarthritis involving the articular surfaces (joints and discs) of the spine, often with osteophyte formation and cord or root compression SPONDYLOLISIS : refers to a separation at the pars articularis, which permits the vertebrae to slip. Maybe uni or bilateral

    THE DISTINCTION AMONG SPONDYLOSIS, SPONDYLOLISIS AND SPONDYLOLISTHESIS

    SPONDYLOLISTHESIS : May result from bilateral pars defects or degenerative disc disease. Defined as the anterior subluxation of the suprajacent vertebrae, often producing central canal stenosis : it is the slipping forward of one vertebrae on the vertebrae below.

    INFECTION
    Epidural abcess Vertebral osteomyelitis Septic discitis Potts disease (tuberculosis) Nonspecific manifestation of systemic illness

    NEOPLASM
    Epidural or vertebral carcinomatous

    metastases

    Multiple myeloma Lymphoma

    DEGENERATIVE

    1. Osteoarthritis 2. Rheumatoid arthritis 3. Thoracic Outlet Syndrome 4. Cervical Spondylosis 5. Marie-Strumpell disease 6. Lumbar disc prolaps (Hernia Nukleus Pulposus (HNP) 7. Spinal Stenosis

    The disc

    Herniated disc

    Distribution
    Lumbar disc prolaps (most commo) L5-S1 (45-50%), L4-5 (40-45%) Cervical disc prolaps C6-7 (69%), C5-6 (19%) Thoracal disc prolaps (infrequent, < 1%)

    Grade

    Protruded disk : penonjolan nukleus pulposus tanpa kerusakan annulus fibrosus Prolapsed disk : nukleus berpindah tetapi tetap dalam lingkaran annulus fibrosus. Extruded disk : nukleus keluar dari annulus fibrosus dan berada di bawah ligamentum longitudinalis posterior. Sequestrated disk : nukleus telah menembus ligamentum longitudinalis posterior.

    Grade of herniated disc

    Clinical symptoms

    Lumbar HNP : * radicular pain * abnormal vertebral posture * paresthesia, parese, diminished tendon reflexes Cervical HNP : * radicular pain, aggravated by neck extension, and reduced by abducting the arm and put it behing the head * paresthesia, parese, diminished tendon reflexes

    Ischialgia (sciatic)

    Diagnosis

    Neurological examination Lumbar HNP :


    * * * * * * Lasegue (straight leg raising) test Crossed Laseque (crossed SLR) test Femoral stretch (reverse SLR) test Lhermitte test Spurlings sign Shoulder abduction test

    Cervical HNP :

    Diagnosis
    RADIOLOGICAL EXAMINATION :

    Plain vertebral x-rays : * limited information * disc narrowing, scoliosis, lordosis lumbal Myelography CT or CT-myelography MRI

    EMG/NCV : 90% abnormal after 1-2 weeks

    Therapy

    CONSERVATIVE * bed rest * orthopaedic mattress * analgetic * pelvic traction (controversial) OPERATIVE Indication :1. Fail conservative treatment 2. Progressive motor dysfunction 3. Recurrence 4. Compression of cauda equina

    LUMBAR SPINAL STENOSIS


    CLINICAL SYMPTOMS :

    neurogenic intermittent claudiation or pseudoclaudication (most frequent) usually bilateral, but maybe unilateral a dull, aching pain the whole lower extremity is generally affected pain provoked by walking and standing, quickly relieved by sitting or leaning forward LBP presents in 65% patients with lumbar spinal stenosis radicular pain is the least common manifestation

    MOST FREQUENT CAUSES OF SPINAL STENOSIS


    > 25 causes are identified The most common : 1. Idiopathic : the result of shorter than normal pedicles, thickened convergent lamina, and a convex posterior vertebral body. 2. Degenerative (50% of cases) : degenerative changes affect the facets posteriorly allowing instability and subluxation, osteophytes form and narrow the nerve root and the central canal ; and the disc anteriorly allowing the disc to bulge into the nerve root and central canal.

    MOST FREQUENT CAUSES OF SPINAL STENOSIS


    3. Degenerative spondylolisthesis : occurs when the facets degenerate, allowing slippage of the upper vertebrae forward over the lower vertebrae. 4. Postoperative : occurs after laminectomy or spinal fusion. Stenosis is produced by bone formation and scar tissue

    INDICATION FOR SURGICAL TREATMENT OF LUMBAR SPINAL STENOSIS

    1. Persistent intolerable pain 2. Limitation of walking distance or standing endurance to a degree that compromises necessary activities 3. Severe or progressive muscle weakness or disturbed bladder of sexual function.

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