FEATURED TOPIC - THE BACK

This 'Featured Topic' is on 'The Back.' This is a suitable starting point for our featured topics as most people in the world will at some point in their life be unable to perform their regular daily activities because of back pain, especially lower back pain. The following articles will hopefully help you understand the workings of the back and therefore offer some insight into back pain, back care, and the treatment of back pain.

ARTICLE 3: LOW BACK PAIN CASE

Define the following terms and discuss their clinical significance.

  1. A patient presents with low back pain and bilateral radicular sciatica with bilateral tingling in the legs on neck flexion; offer three differential diagnosis
  2. What other signs and symptoms might be present with each diagnosis?
  3. How would you recognize urinary retention from the patient's history?
  4. What condition is likely to cause low back pain with signs and symptoms in one leg and signs only in the other?

Low Back Pain Case Answers

  1. 1. A patient presents with low back pain and bilateral radicular sciatica with bilateral tingling in the legs on neck flexion; offer three differential diagnosis.
    • Cauda equina syndrome
    • Multiple sclerosis
    • Bilateral disc herniation with bilateral spinal nerve compression
    • Spinal cord compression (unlikely due to presence of radicular sciatica)

  3. 2. What other signs and symptoms might be present with each diagnosis?

  4. Cauda equina syndrome

    • severe articular signs
    • urinary incontinence or retention depending on the severity of the compression
    • multisegmental hyporeflexia
    • multisegmental paresis
    • multisegmental hypoesthesia
    • absence of clonus or Babinski response

    Multiple sclerosis

    • moderate, mild or absent articular signs
    • urinary retention (neurogenic bladder) if affected
    • extra-segmental hyperreflexia
    • extra-segmental paresis or paralysis
    • extrasegmental hypoesthsia or anesthesia
    • Babinski response and clonus

    Bilateral disc herniation with bilateral compression spinal nerve syndromes

    • Extremely rare and perhaps the least likely explanation. There would be hyporeflexia, motor and sensory segmental palsies

    Spinal cord compression

    • Extrasegmental hyperreflexia, clonus, Babinski responses, hypertonicity, urinary retention

  5. 3. How would you recognize urinary retention from the patient's history?
    • Stress incontinence due to pelvic floor weakness
    • Cauda equina syndrome with S4 palsy
    • Bladder infections
    • Pregnancy
    • Prostatism
    • Pelvic cancers

  7. 4. What condition is likely to cause low back pain with signs and symptoms in one leg and signs only in the other?
    • Mutliple sclerosis

 

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