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back pain algorithm ravi

algorithmic diagnosis of back pain.

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back pain algorithm ravi

  1. 1. Back Pain Algorithm Ravi shankar sharma
  2. 2. Low back pain • Low back pain is defined as lumbar spinal pain or sacral spinal pain or any combination of the two.
  3. 3. Idea of pain generator A structure/tissue can be a source of pain only when it will have nociceptive nerve Local anesthetic injection in those nerves and/or those tissue should relieve pain
  4. 4. Pain Generators • Facet joints • Deg. Disc • Sensitized ms • S.I. Joints Not a Pain Generator • Normal muscle • Normal Disc
  5. 5. Major causes 1. Facet joint arthropathy 15-45% (M.C.Cz in elderly) 2. Interval disc disruption 25-40% (M.C.Cz in young) 3. Sacro-Iliac joint arthropathy 15-30% 4. Disc prolapse/ herniated disc/ slipped disc-2-5% 5. CRPS/ RSD 2-8% Causes of Low Back Pain
  6. 6. Other causes of Low Back Pain Osteoporotic Compression fracture 3-5% Other fracture <1% Fibromyalgia & Myofascial Pain 2-5% Spinal canal stenosis 2-3% Spondylolisthesis 2-3% Tumor <1% Infection <1% Others: like FBSS <1%
  7. 7. Low Back Pain : RED FLAGS • Possible FRACTURE • Possible TUMOR OR INFECTION. • BLADDER OR BOWEL DYSFUNCTION. • Severe or PROGRESSIVE NEUROLOGIC DYSFUNCTION in the legs. • MAJOR MOTOR WEAKNESS in quadriceps, plantar flexors, evertors, and dorsiflexors.
  8. 8. History Chief complain/s H/O Present illness Site Onset Intensity Radiation Aggravating & relieving factors Diurnal variation Family history Medical history Personal history Occupational history
  9. 9. Examination • Inspection • palpation • Range of movements • Special tests
  10. 10. Facet Joints Commonest cause of back pain in elderly.
  11. 11. Facet Joint pain Back pain > leg pain Paramedian pain Pain on extension, rotation, lateral bending Tenderness over facet joints Non dermatomal distribution
  12. 12. Management of Facet Arthropathy • Confirmation by dual diagnostic block (L.A.’s) • I/Articular Depo-steroid inj. • Radio-frequency Rhizotomy of Medial branch
  13. 13. Radio-frequency Rhizotomy of Medial branch
  14. 14. Degenerative Disc Disease
  15. 15. Grading:-
  16. 16. Disc Prolapse
  17. 17. DISC PROLAPSE
  18. 18. TYPES OF DISC PATHOLOGY Degenerated Disc/ IDD/Discogenic Pain No nerve root compression Non-dermatomal distribution of pain Back pain > leg pain Incidence: 40% Herniated Disc/ Prolapsed/Slipped D Nerve root compression Dermatomal distribution of pain Back pain < leg pain Incidence: 4%
  19. 19. Types of disc pathology Degenerated Disc Axial pain, SLR –ve Neuro-deficits -ve Provocative discogram/ HIZ in MRI correlates with pain Herniated Disc Lateral pain,SLR+ve Neuro-deficits + Clinical + MRI
  20. 20. Internal disc disruption • IDET/ Posterior annuloplasty • Neucleoplasty • Laser Discectomy • Conventional radio-frequency lesioning • Pulsed radio-frequency lesioning • Percutaneous Discectomy • Ozone Nucleolysis/ ozone Discectomy • Surgery: Fusion, Disc replacement
  21. 21. Ramus communicans block via c-arm (AP/lateral )
  22. 22. DISC PROLAPSE Epidural steroid inj Ozone Nucleolysis & Transforaminal Ozone injection. Epidural neuroplasty Percutaneous discectomy Surgery: Discectomy/ laminectomy/ Fenestration
  23. 23. Sacro-iliac Joint Arthropathy FABER test
  24. 24. S.I.joint RF ablation –Needle Placement
  25. 25. Myofascial Pain Syndrmoes:
  26. 26. Vertebral compression #
  27. 27. Vertebroplasty
  28. 28. Interspinous ligament sprain
  29. 29. Low back pain Back pain >leg pain Axial pain Paramedian pain
  30. 30. Axial pain Aggravated by sitting -No tenderness -No other signs except painful deep percussion M.R.I showing HIZ I.D.D R.Com.block Epidurals M.R.I showing # with edema Vertebral compression # Vertebroplasty Local tenderness + b/w spinous area I.S. ligament sprain Over coccyx Coccydynia Steroid inj.
  31. 31. Axial pain ↓on sitting No local tenderness Neurogenic claudication + Extension ↑ leg pain MRI- canal dia. <10 mm b/l p/median tenderness+ Extension↑ back pain Neurodeficit/leg pain - Canal stenosis Epidurals/Sx Diagnostic facet jnt. inj.+ve I/Articular steroid/ R.F of medial branch
  32. 32. Paramedian pain↑ on sitting Tenderness over Q.L. Trigger point inj. + ve Tenderness over buttock+ FAIR +ve Piriformis T.P. inj.+ Tenderness over S.I. jnt. FABER + ve Diag. S.I. jnt.inj .+ ve Repeat T .P. inj./Botox Repeat T . P.inj./Botox I/A steroid /R.F.
  33. 33. Paramedian pain ↓ on sitting Deep tenderness of paraspinal muscle+ Extension ↑ pain Diag. Psoas T.P. inj.+ ve Repeat T.P.inj./Botox Local tenderness over facet+ Extension ↑pain Diagnostic facet jnt. inj.+ve I/Articular steroid/ R.F of medial branch
  • AliAbbaskhaniDavanlo

    Aug. 18, 2020
  • HassnaaElkholy

    Dec. 18, 2018

algorithmic diagnosis of back pain.

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