5 Diagnostic Triage For Back Pain

he main diagnostic indicators for simple backache,nerve root pain and possible serious spinal pathology are outline below:

     1. Simple backache:-

• Onset generally age 20-55 years.
• Lumbosacral region,buttocks and thigh.
• Pain mechanical in nature

          -varies with physical activity

          -Varies with time

• Patient well
• Prognosis good (90% recover from acute attack in 6 weeks)

    2. Nerve root pain:-

• Unilateral leg pain>back pain
• Pain generally radiates to foot or toes
• Numbness and paraesthesia in the same distribution
• Nerve irritation signs

        – reduced straight leg raising which reproduces leg pain

• Motor,sensory or reflex change

        – limited to one nerve root

• Prognosis reasonable

        – (50% recover from acute attack within 6 weeks)

    3. Possible serious spinal pathology

• Age of onset<20 or>55 years
• Violent trauma: r.g.fall from a height,road traffic accident
• Constant,progressive , non-mechanical pain
• Thoracic pain
• PMH-carcinoma
• Systemic steroids
• Drug abuse,HIV
• Systemically unwell
• Weight loss
• Persisting severe restriction of lumber flexion
• Widespread neurology
• Structural deformity

  4. Cauda equina syndrome/widespread neurological   disorder

• Difficulty with micturition
• Loss of anal sphincter tone or faucal incontinence

       If there are suspicious clinical features,or if pain has not settled in 6 weeks,an ESR and plan X-ray should be considered.

• Saddle anesthesia about the anus,perineum or genitals
• Widespread (>one nerve root)or progressive motor weakness in the legs or gait disturbance.

  5. Inflammatory disorder (ankylosing spondylitis and related disorders)

• Gradual onset
• Marked morning stiffness
• Persisting limitation of spinal movements in all direction
• Peripheral joint involvement
• Iritic,skin rashes (psoriasis),colitis,urethral discharge
• Family history