Case presentation Backache Dr F Pato MBCHB (Stell)

Case presentation

BackacheBackache

Dr F PatoMBCHB (Stell)

Presenting history

• 44yr male

• Sudden onset backache while driving

• Non-radiating

• Unable to move as a result thereof.

• No neurological symptoms.

• First episode of such complaint.

• No other complaints

Previous history

• PMH: DM for 1yr,

• PSH: Nil

• Meds: Daonil

• Allergies: Nil

• Social: Smoking- alcohol-

Clerical work

Sedentary lifestyle,

Examination

• GCS 15/15

• Height 1.68m

• Weight 79kg

• BMI 27.9

• Vitals within normal limits

• CARDIOVASCULAR– Pulses regular and equal

– Cap refil <3s

– No abnormalities noted

– S1 S2

RESP

•No signs of distress

•Equal chest expansion

•Resonat percussion

•Air entry good bilaterally

ABDOMEN•Central obesity

•Bowel sounds present

•Soft and non-tender

•No organomegaly palpable

• Patient moving• N0 deformities/ scars• Tender over lower back

NEURO• Power 5/5• Tone normal• Reflexes intact• Sensation intact (3/3)

Examination cont.

Assessment:– ?mechanical backache

– ?muscle spasm

– ?slipped vertebral disc

– ?fracture

Managemnet

• X-ray

• Analgesia

• Bed rest

• Orthopaedics consult

• CT scan not working• MRI not available

Loss of function, income, disability

Discussion: Backache

• +/- 80%

• Self limiting

• Disabling disease

• 75% spontaneous recovery 2-3/52

• 5% ends up with surgery

• Classified according to age group

Children

• Red flag

• trauma

• infectious conditions: discites vertebral osteomyelitis.neoplastic condition

Teenagers

• Postural

• Deformities

• Trauma

• Infections

Young adults• 20-40yrs

• Occupation

• Disc lesions

• Ankylosing spondylitis

• Trauma

• Infective conditions

• Spondylolysis

• Spondylolisythesis

Older adults

•Degenerative conditionsScoliosis L4/L5Spondylolisthesis 5F’s

• Spinal stenosis• Malignancy• Weight• Osteoporosis• Vascular

Other conditions

• Urogenital

• Gastrointestinal

• Gynaecological

Approach to backache

• Good clinical history• Careful examination• Well planned special examinations• Management

Good clinical history

•Onset

•Duration

•Aggravating and alleviating factors

•Distribution

•Grading

Thorough examination•Look•Feel•Move: flexion, extension, lateral flexion, rotation, muscle power•Full neurological examination: •Motor•sensory (3-point scale) distribution •Reflexes

• Well planned special examinations

• Xrays

• MRI

• Myelography

• Radio isotopes

• Serology

• Management

• Conservative vs surgery

• Conservative

• Physiotherapy

• Kinetic handling, mobilization, muscle balancing, symptomatic treatment

• Medication

• Work placement

–Surgery

–Failure of conservative management

–Unstable fractures

–Pathological fractures

–Disc herniation and root compression

–Complications

bibliograpy

• Concise system of orthopaedics and fractures 2nd edition, A G Apley. L Solomon

• Current surgical diagnosis and treatment 11th edition, L W Way. GM Doherty

• Lecture notes, Prof JGVlok, Stellenbosch university,2005

• Vlok JG, backache: a great medical problem, SA Orthopaedic Journal,Aug,2006,18-24