By: Dr. Julio Enrique Rosado, FAANS
Neurosurgeon – MCS Provider Network
Lumbar pain, commonly known as lower back pain, is one of the most common conditions in humans, with a wide
range of symptoms. According to official statistics, around 80% of the population experiences this pain at
some point in life.
Globally, lumbar pain is recognized as the condition that represents the greatest disease burden for modern
medical practices (Global Disease Burden, 2013). About 90% of initial or follow-up contacts for this problem
occur in primary care physicians’ offices and emergency rooms. However, only 10% of these patients require
treatment at hospital facilities or equivalent specialized services.
The challenge lies in identifying how serious the lumbar condition is – if it’s a danger to the patient’s
life or functionality. Most medical visits categorized as back pain are seen as events with no long-term
repercussions. These patients relieve their pain with or without treatment between six and eight weeks.
However, patients who present risks of neurological damage or manifestations of systemic conditions must
receive proper management immediately, and this will depend on an accurate and timely diagnosis.
When receiving a patient with complaints of back pain, the following is recommended:
Review the patient’s history related to the main complaint (location, intensity, and time of
presentation)
Perform a physical exam:
- Observe standing and sitting movements
- Observe the alignment in sagittal and coronal balance
- Observe the gait
- Evaluate non-organic components (Waddell signs)
- Deep tendon and cortico-spinal reflexes
- Mandatory palpations
- Analyze Lasegue Sign
- Provocative sacroiliac examination: 3/5 positive, 95% specificity
Formulate a hypothesis about possible and differential diagnoses (mechanical and neurological, among others).
Issue orders for acute treatments, and if necessary, perform additional studies (MRI, Cervical CT, and X-rays, among others).
As for the cause of the pain, the following indicators must be considered:
Trauma after an incident
Back pain that lasts more than three months, and its intensity (indicator that needs more exploration)
Urine retention, loss of intestinal or urinary control
Fever
Osteoporosis
Suspected or history of cancer
Night sweats, severe fatigue, or unintentional weight loss
Guided by this, it is important to define these indicators to achieve an accurate diagnosis and refer the appropriate treatments, either with cognitive therapies, exercises, chiropractic or physiatrist care, steroids, and muscle relaxants, among others. Through this systematic and reproducible clinical analysis, adequate and successful clinical management is achieved, ensuring safety and wellness for the patient.
References:
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Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: A Systematic Analysis for the Global Burden of Disease Study, 2013. HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP).
