Diagnostic Imaging for Low Back Pain (LBP)

Diagnostic Imaging for LBP

• Abnormal radiology pattern is not a reliable indicator of LBP causes
• Asymptomatic patients over 60 years old:
  • 36% have disc herniation
  • 21% have spinal stenosis
  • >90% have disc degeneration

Indications of Radiology Study for LBP

• Not specified in the text

Pharmacologic Treatment for LBP

• Pain pathway and pharmacological interventions:
  • Local anaesthetics, antihistamines, and anti-inflammatory agents for direct pain relief at the site of injury
  • Opioids and non-opioid drugs (e.g. morphine, cannabinoids, COX-2 inhibitors, α2 agonists, gabapentin, acetaminophen, and tricyclic anti-depressants) acting peripherally and centrally to attenuate pain signaling transmission

Interventional Techniques for LBP

• Steroid injection and neural blockade
• Deep brain stimulation (DBS)
• Percutaneous neuromodulation therapy (PENS)
• Spinal cord stimulation
• Transcranial and epidural stimulation
• Neuroablative procedures
• Stimulation of dorsal root ganglia (DRG) and peripheral nerve or nerve field

Summary

• LBP must be addressed as a complex disease requiring accurate diagnosis of pain generators before treatment
• Multimodal and multidisciplinary approach is essential to determine a strategy to solve the problem, not just alleviate symptomatic pain
• Careful follow-up is necessary to adapt therapeutic strategies to dynamic clinical manifestations of CLBP

Diagnostic Procedures for LBP

Anamnesis

• Specific radicular pain or spinal stenosis
• Non-specific LBP

Red Flags

• Not specified in the text

Yellow Flags

• Not specified in the text

Physical Examinations

• Disc herniation:
  • SLR positive: Sens 91%, Spec 26%
  • Crossed SLR: Sens 29%, Spec 88%
  • Centralization phenomenon: increases
• Spinal stenosis:
  • 20% asymptomatic
  • Diagnosis based on history and PE
  • Neurogenic claudication (pseudoclaudicatio)
• Facet joint pain:
  • Degeneration process
  • Spine injury
  • Fracture
  • Tear ligamentum flavum
  • Disc problem

Sacroiliac Joint Pain

• Distraction test
• Compression test
• Thigh thrust test
• Patrick's sign
• Gaenslen's test
• SI joint block: moderate specificity and validity
• Radiology diagnosis: not accurate
• Bone scan: sensitivity is low/limited

Myofascial Low Back Pain

• Quadratus Lumborum
• Gluteus medius
• Para iliopsoas
• Abdominis rektus

Back Pain

• Definition: a complex unpleasant phenomenon composed of sensory experiences including time, space, intensity, emotion, cognition, and motivation
• Yearly prevalence: 5-65%
• Lifetime prevalence: up to 84%
• Monthly prevalence: 35-37%
• High rate of disability and medical costs associated with back pain