Bones and Joints
A. Sahib El-Radhi in Paediatric Symptom and Sign Sorter, 2019
Back pain is a common complaint in adults, but it often begins in children and adolescents. It is one of the most reported health problems worldwide and a leading cause of disability, activity limitation and school absences. Low back pain is the most common type of back pain and is defined as pain limited to the region between the lower margins of the 12th rib and the gluteal folds, with or without referred leg pain. The majority of causes of back pain have an underlying musculoskeletal or biochemical origin, such as trauma, muscle strain or infectious and inflammatory diseases. Acute onset of pain is suggestive of trauma or infection, while insidious onset may suggest inflammatory or neoplastic aetiology. Localised back pain may suggest stress fracture, while non-localised pain is often secondary to muscular or inflammatory cause. Pyelonephritis is an important cause of back pain.
Malingering
Alan R. Hirsch in Neurological Malingering, 2018
Back pain symptoms range from the simple backache, which most people have at some time in their lifetime, to serious spinal diseases and lower back disabilities. Since the time of Hippocrates deformities and fractures have been well documented (Allan and Waddell, 1989). Lower back pain has been described with such diseases; however, most speculate that it was just a simple backache and have received little medical attention. The question then becomes, when is it a simple backache and when is it regarded as a medical problem? The nineteenth century laid the foundation for the current approach to back pain. A physician, Brown, in 1828 wrote a paper in the Glasgow Royal Infirmary on spinal irritation and documented for the first time that the nervous system and vertebral column could be the source of back pain (Allan and Waddell, 1989). Papers continued to follow thereafter; however, the exact pathology was never shown for back pain and eventually the diagnosis disappeared. Nevertheless, today the thought of vertebral and nervous system irritation remains, and a thorough history, evaluation, and diagnosis is required.
The Back
Louis Solomon, David Warwick, Selvadurai Nayagam in Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
With increasing age, as the lumbar intervertebral discs gradually dry out, the nucleus pulposus changes from a turgid bulb to a brownish, desiccated structure. The annulus fibrosus develops fissures parallel to the vertebral end-plates running mainly posteriorly, and small herniations of nuclear material squeeze into and through the annulus. The discs flatten down and bulge slightly beyond the margins of the vertebral bodies. Where they protrude against the surrounding ligaments, reactive new bone formation produces bony ridges (erroneously called ‘osteophytes’) and the adjacent vertebral end-plates ossify and become sclerotic. The picture as a whole is referred to as spondylosis; it occurs in over 80% of people who live for more than 50 years and, although characteristic changes can be seen on x-ray examination (flattening of the disc ‘space’ and marginal spur formation), the condition is usually asymptomatic. However, other secondary effects may ensue: slight displacement of the posterior vertebral facet joints, facet joint osteoarthritis and narrowing of the lateral recesses of the spinal canal and the intervertebral foramina. It is then that patients experience the common and ill-defined symptoms of recurrent backache, sometimes with pain radiating towards the buttocks or thighs.
New Horizons of Knowledge in Intervertebral Disc Disease
Published in Journal of Investigative Surgery, 2021
Silvia Ravalli, Giuseppe Musumeci
Intervertebral disc disease (IVDD) refers to degenerative processes of the spine resulting in reduced shock-absorbing ability, which may ultimately lead to disc herniation and spinal cord compression. Back pain is associated with this condition, representing the clinical feature mostly frequently referred by the patients. The etiology, as for many musculoskeletal diseases, should be sought in environmental and genetic factors. These latter involve genes which are responsible for Collagen type IX and I, Aggrecan, Vitamin D receptor, while non-hereditary factors include primarily mechanical injuries, excessive loads and uneven weight distribution, as well as aging, obesity, chronic inflammation, and work-related risk factors like long sitting sessions, e.g. while driving, or non-ergonomics office equipment [1]. It is estimated that more than 200 million cases of lumbar degenerative spine disease occur, each year, worldwide, significantly contributing as a major cause of disability and socio-economic burden [2].
Granulomatosis with polyangiitis in a patient with a thoracic vertebral lesion: a case report
Published in Modern Rheumatology Case Reports, 2021
Keishu Kawanishi, Hiroki Nishiwaki, Naoto Kawata, Shinya Omiya, Yoshihiko Inoue, Fumihiko Koiwa
GPA causes systemic microvascular disease and granuloma formation, but vertebral lesions are rare. In total, 19 cases of vertebral lesions due to GPA have been reported in the literature [9–19], with varying ages and sexes (Table 2). Of the 20 cases, 11 were PR3-ANCA-positive, six were MPO-ANCA-positive, and three were negative for ANCA. The rates of PR3-ANCA positivity, MPO-ANCA positivity, and ANCA-negativity were reported to be 65–75%, 20–30%, and 5%, respectively [2]. Although the number of cases was limited, the percentage of ANCA-negative cases was higher in cases of GPA with vertebral lesions than in typical GPA. In our case, the patient complained of back pain; imaging of the vertebrae was subsequently performed, and lesions were found. Of the 20 cases previously reported (Table 2), only eight had subjective symptoms suggestive of vertebral lesions [10,12–14,16–19]: seven presented with back pain in the thoracic to the lumbar region, and one case presented neck pain [18]. The lesions involved the cervical vertebrae in two cases [15,18], and the lumbar and sacral vertebrae in one case [16,19]; the others mainly occurred in the thoracic vertebrae. GPA and other ANCA-associated vasculitides are commonly associated with pulmonary lesions, and vertebral lesions may be found incidentally on chest CT scans even in the absence of symptoms of vertebral lesions. This may account for the high number of reported thoracic spine lesions.
Paracetamol for low back pain: the state of the research field
Published in Expert Review of Clinical Pharmacology, 2020
Bart Koes, Marco Schreijenberg, Alexander Tkachev
In most people with low back pain, the precise cause of the pain is unknown. In only a small proportion (up to 5–10%) of patients presenting in primary care underlying pathologies, such as malignancies, fracture, infections can be identified. When specific pathologies explaining the back pain are not present, the complaints are labeled as being nonspecific. It hampers adequate treatment that in most cases no cause of the pain can be found, since no causal treatment can thus be applied. Consequently, many treatments for low back pain are focused on reduction of symptoms. There are many treatments available for people with back pain. This includes non-pharmacological treatments (patient education, exercises, manual therapies) and pharmacological treatments (mostly pain medications, including paracetamol) [16]. Some patients suffering from low back pain also receive surgery. Especially patients with persisting radicular pain (>6–8 weeks) in the leg due to a herniated disk are regarded as surgical candidates. At the same time, there is good evidence that recovery rates after 1 and 2 years follow up are more or less similar between patients receiving disc surgery or prolonged conservative care [17]