Chronic Lower Back Pain Quiz

Types of Back Pain

• The most common type of back pain is lower back pain.
• Lower back pain affects approximately 80% of the population during their lifetime.

Causes of Back Pain

• The second most common reason for office visits in the United States is lower back pain.
• The most common cause of lower back pain is back strain.
• The etiology of pain from back strain is muscle or ligament injury.

Radicular Pain

• The most common type of nerve root affected in radicular pain is the L5 nerve root.
• Radicular pain is a type of pain that radiates from the spine to the extremities, whereas referred pain is a type of pain that is felt in a different area than the source of the pain.

Physical Examination

• The straight leg raising test (SLRT) is used to diagnose lower back pain and nerve root compression.
• The SLRT is used to assess for pain or tightness in the lower back and legs.
• A negative SLRT test loses its reliability in ruling out a herniated disk after the age of 35.

Imaging

• Imaging (radiographs or MRI) is indicated for a patient with lower back pain if they have a history of cancer, infection, or trauma, or if they have a neurological deficit.
• Imaging is also indicated if the patient's symptoms persist or worsen over time.

Herniated Disks

• The most common level of disk herniation is L5-S1.
• The most likely nerve root to be impinged by a posterolateral herniation is the L5 nerve root.
• The most common presenting symptom of herniated disks is back pain that radiates to the legs.
• The L4 nerve root is compromised with involvement of the L4 nerve root, which can cause weakness in the quadriceps muscle.
• Imaging is indicated for a patient with herniated disks if they have a neurological deficit or if their symptoms persist or worsen over time.
• Approximately 95% of patients with herniated disks will improve with conservative treatment over a period of 5 years.

Spinal Stenosis

• The most common cause of spinal stenosis is degenerative changes in the spine.
• The typical age range for patients with spinal stenosis is 60-70 years old.
• Indications for surgery in patients with spinal stenosis include progressive neurological deficit, intractable pain, or bowel or bladder dysfunction.
• The recommended imaging technique to visualize the stenotic region in a patient with suspected spinal stenosis is MRI.
• The first-line treatment for most patients with spinal stenosis is conservative therapy.

Spondylolisthesis

• The most common cause of spondylolisthesis is degenerative changes in the spine.
• The most commonly affected area in spondylolisthesis is the L5-S1 level.
• The most effective radiographic study to diagnose spondylolisthesis is a lateral lumbar spine radiograph.

Cauda Equina Syndrome

• The most common cause of cauda equina syndrome is a herniated disk.
• The necessary symptom for a diagnosis of cauda equina syndrome is bowel or bladder dysfunction.
• The recommended timeframe for emergent surgical decompression if cauda equina syndrome is diagnosed is within 24-48 hours.
• The initial urinary symptoms experienced by patients with cauda equina syndrome are urinary retention, incontinence, or decreased urinary sensation.