Back pains are very common. It is one of the top 10 reason to see a doctor. Back pains can be mechanical such as herniated disc or can be inflammatory such as in Spondyloarthritis.
Mechanical back pain improves with rest but becomes worse with activity.
Inflammatory back pain becomes worse with rest and improves with activity.
Work-up: Both types of back pains may need additional evaluation such as X-rays and/or MRI and blood tests including ESR (and HLA-B27 if back pain appear to be inflammatory) if there is
1. No improvement despite bed rest, streching exercises, and Medications for 2-3 weeks
2. Weakness in the lower extremities
3. Fever with generalized findings of lymph node enlargement, weight loss, and fatigue
4. History of steroid use
5. History of substance and IV drug use
6. Patient is over the age of 50
7. Previous cancer history
8. History of trauma or fall
9. Patient is immunocompromised
10. Patient is on a biologic therapy such as Humia, Enbrel, Remicade
11. History of osteoporosis
Referral to Neurosurgery is indicated if there is:
1. Cauda Equina Syndrome. This constitutes an emergency and requires immediate surgical evaluation. It presents usually with bowel and bladder problems such as urinary retention, weakness in both legs, and numbness in both legs as well as buttocks, perineum and inner thighs (saddle anesthesia).
2. Ongoing pain, weakness, and numbness in lower extremities.
3. Worsening of weakness or numbness.
Click here for more information about mechanical back pain.
Click here for more information about inflammatory back pain.
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