Back Pain - Sciatica

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Back Pain - Sciatica

NIH - Medical Encyclopedia Back pain - low

"The specific structure in your back responsible for your pain is hardly ever identified. Whether identified or not, there are several possible sources of low back pain: • Small fractures to the spine from osteoporosis • Muscle spasm (very tense muscles that remain contracted) • Ruptured or herniated disk • Degeneration of the disks • Poor alignment of the vertebrae • Spinal stenosis (narrowing of the spinal canal) • Strain or tears to the muscles or ligaments supporting the back • Spine curvatures (like scoliosis or kyphosis) which may be inherited and seen in children or teens • Other medical conditions like fibromyalgia. "

Highlighted Article

Treatment of acute sciatica. (Am Fam Physician. 2007)

"Acute sciatica is lower back pain with radiculopathy below the knee and symptoms lasting up to six weeks. … caused by a variety of conditions: disk herniation, lumbar spinal stenosis, facet joint osteoarthritis or other arthropathies, spinal cord infection or tumor, or spondylolisthesis. … Clinical Commentary: An efficient clinical history and thorough physical examination of a patient with suspected sciatica is needed to rule out urgent conditions like cauda equina syndrome, infection, or cancer, and to determine the need for diagnostic tests. After the acute episode, emphasis is placed on activity, back exercises, behavioral techniques, ergonomics education, and close clinical monitoring. Educating patients on self-care and establishing reasonable expectations usually increase patient compliance with therapy and improve satisfaction."

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Back Pain and Sciatica

Diagnosis, Imaging, and Screening

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Back Pain in Adolescents: Assessment With Integrated 18F-Fluoride Positron-emission Tomography-Computed Tomography. ( Pediatr Orthop. 2007) "Ten patients had positive findings that included 4 cases of spondylolysis (3 of them active), 3 frank fractures (2 of the transverse process and 1 of the facet), 2 osteoid osteomas, 1 osteitis pubis, 1 sacroiliitis, and 2 herniated disks. Three patients presented 2 coexisting pathologies. … The 18F-fluoride PET-CT can detect spinal lesions with high diagnostic accuracy in adolescents with back pain. Considering the associated costs and radiation exposure, it should be used at present only in cases of long-standing and disabling back pain in which other imaging modalities were inconclusive."

Classification of low back-related leg pain-A proposed patho-mechanism-based approach. (Man Ther. 2007 )

Diagnostic differences between general practitioners and orthopaedic surgeons in low back pain patients. (Ups J Med Sci. 2007)

Differential Diagnosis of Endometriosis in a Young Adult Woman With Nonspecific Low Back Pain. (Phys Ther. 2007)

Electromyographic and magnetic resonance imaging to predict lumbar stenosis, low-back pain, and no back symptoms. (J Bone Joint Surg Am. 2007) "CONCLUSIONS: This prospective, controlled, masked study of electrodiagnosis and magnetic resonance imaging for older subjects showed that imaging does not differentiate symptomatic from asymptomatic persons, whereas electrodiagnosis does. We believe that radiographic findings alone are insufficient to justify treatment for spinal stenosis."

[Inflammatory low back pain] (Rev Med Brux. 2007) "It is important to identify patients with inflammatory back pain (5 to 10 %) because the management and the treatment are different. Spondylarthropathies, especially ankylosing spondylitis (AS) are the most frequently encountered. The inflammatory characteristics of pain give clues for the diagnosis and allow to make appropriate management."

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