Back pain

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Due to almost epidemic proportions of patients presenting to general practitioners, general orthopaedic clinics, and accident and emergency departments, a working knowledge of the assessment of the patient presenting with back pain, as well as an idea of the possible causes and their treatment is essential. The vast majority of patients presenting with back pain of a musculoskeletal origin will have symptoms secondary to degenerative spinal disease. Other conditions can occur such as trauma, infections and inflammatory spondyloarthropathies. Visceral causes can also represent with very symptoms that mimic back pain.

A simple pathological classification of spinal disorders includes:

• Congenital lesions (e.g. spina bifida, sacral agenesis, diastematomyelia).

• Developmental anomalies (e.g. scoliosis (Fig. 22.36), Schuermann's kyphosis, isthmic or dysplastic spondylolisthesis, spondylolysis (Fig. 22.37)).

• Acquired conditions:

- Degenerative (e.g. degenerative lumbar disc disease, spondylolisthesis, facet joint arthropathy).

- Traumatic (e.g. burst fractures to the vertebral body, fracture dislocations thoracolumbar junction resulting in a post-traumatic kyphosis).

- Infective (e.g. tuberculosis of the spine, bacterial vertebral osteomyelitis, discitis).

- Inflammatory (e.g. HLAB 27-positive spondyloarthropathy, seronegative spondyloarthropathies).

- Neoplastic (e.g. primary bone or soft-tissue tumours, metastases mainly from the kidney, thyroid, prostate, lung, breast, bowel).

- Iatrogenic (postsurgical) (e.g. postlaminectomy syndrome).

- Psychogenic.

- Metabolic.

- Miscellaneous (e.g. 'visceral' abdominal aortic aneurysm, pancreatitis, renal/ureteric calculi, soleus abscess, peptic ulceration).

- Idiopathic.

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Back Pain Revealed

Back Pain Revealed

Tired Having Back Pains All The Time, But You Choose To Ignore It? Every year millions of people see their lives and favorite activities limited by back pain. They forego activities they once loved because of it and in some cases may not even be able to perform their job as well as they once could due to back pain.

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