quick reference
red flags
| Symptoms | Corresponding Pathology |
|---|---|
| Age under 18 years | Congenital abnormality |
| Age over 50 years | Fracture, malignancy |
| Anticoagulant use | Spinal hematoma |
| Fever | Infection, malignancy |
| Genitourinary issues including urinary retention/incontinence or sexual dysfunction | Cauda equina syndrome |
| Immunocompromised | Fracture, infection |
| IV drug use | Infection |
| Recent spinal surgery or epidural injection | Infection, spinal hematoma |
| Trauma | Fracture, spinal hematoma |
| Signs | Corresponding Pathology |
|---|---|
| Reduced anal sphincter tone | Cauda equina syndrome |
| Hyperreflexia | Acute cord compression |
| Hyporeflexia/areflexia | Cauda equina syndrome |
| Lower extremity muscle weakness | Acute cord compression or Cauda equina syndrome |
| Saddle paresthesia/anesthesia | Cauda equina syndrome |
| Absent or decreased bulbocavernosus reflex | Cauda equina syndrome |
clinical features
- May also be called lumbago, referring to pain in the muscles and joints of the lower back
- Pain lasting > 6 weeks is risk factor for more serious disease
- Night pain and unrelenting pain are worrisome symptoms
- Back pain in IV drug user is spinal infection until proven otherwise
- 95% of herniated discs occur at L4-L5 or L5-S1 (for both pain extends below the knee)
diagnosis
DDx:
Chronic:
Lumbago
Sciatica
Spondylosis
Spondylysis
Spondylolisthesis
Scary:
Discitis/Osteomyelitis
Spinal Epidural Abscess