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Back Pain


  • 60-80% of people will have LBP sometime in their lives.
  • 30% are referred to Ortho; 3% admitted; 0.5% operated.
  • 90% LBP resolves in 6w, 75% may experience symptoms & disability one year after initial consultation.
  • The prevalence of LBP has changed little over the years, but the associated disability has increased four fold since the 1970s. 
  • In the UK certified incapacity for LBP was 120 milion days in 1996/7. 
  • Overall cost of LBP in 1993 was £6 billion. 14 million consultations in 1993.

Differential Diagnosis according to Age:

  • Children
    1. congenital disorders
    2. developmental disorders
    3. infection
    4. primary tumours - eosinophilic granuloma, ewing's sarcoma, metastatic neuroblastoma, spinal cord tumours
  • Young Adults
    1. disc disease
    2. spondylolisthesis
    3. fractures
    4. Scheuermann's disease
    5. Ankylosing spondylitis
  • Older Adults
    1. spinal stenosis
    2. metastatic disease
    3. osteopaenic fractures
    4. infection

Types of Back Pain:

  1. Discogenic back pain
    • pain from the innervated ligamentous layer of the annulous fibrosis when it is stretched with a bulging disc
    • it is midline & worse with lordotic postures, bending & lifting
  2. Radicular back pain
    • pain extending to the buttock and/or leg
    • associated with disc herniation or spinal stenosis or intraspinal pathology
  3. Referred back pain
    • Aortic Aneurysm
    • Visceral (ulcer, PID, endometriosis, gallbladder disease, pleural disease)
    • Infection
    • UTI, PID
    • Hip Arthritis
  4. Iatrogenic back pain
    • dural adhesions 
    • post surgical instability
    • post operative discitis; arachnoiditis
  5. Psychogenic back pain
    • must exclude organic pathology
    • Waddell's inappropriate signs often present

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Ankylosing Spondylitis
Back Pain
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