Summary of diagnostic guidelines for spinal pain

• Continuous pain (day and night) = neoplasia, especially malignancy or infection.

• The big primary malignancy is multiple myeloma.

• The big three metastases are from lung, breast and prostate.

• The other three metastases are from thyroid, kidney/adrenal and melanoma.

• Pain with standing/walking (relief with sitting) = spondylolisthesis.

• Pain (and stiffness) at rest, relief with activity = inflammation.

• In a young person with inflammation think of ankylosing spondylitis or Reiter's disease.

• Stiffness at rest, pain with or after activity, relief with rest = osteoarthritis.

• Pain provoked by activity, relief with rest = mechanical dysfunction.

• Pain in bed at early morning = inflammation, depression or malignancy/infection.

• Pain in periphery of limb = discogenic ^ radicular or vascular ^ claudication or spinal canal stenosis ^ claudication.

• Pain in calf (ascending) with walking = vascular claudication.

• Pain in buttock (descending) with walking = neurogenic claudication.

• One disc lesion = one nerve root (exception is L5-S1 disc).

• Two or more nerve roots—consider neoplasm.

• The rule of thumb for the lumbar nerve root lesions is L3 from L2-L3 disc, L4 from L3-L4, L5 from L4-L5 and S1 from L5-S1.

• A large disc protrusion can cause bladder symptoms, either incontinence or retention.

• A retroperitoneal bleed from anticoagulation therapy can give intense nerve root symptoms and signs.

Was this article helpful?

0 0
Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

Get My Free Ebook

Post a comment