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What are the red flags of back pain? Name 6.
- Cauda equina syndrome features e.g. urinary retention, neuro Sx
- Trauma (significant)
- Weight loss
- Hx of cancer
- Aged 50+
- Corticosteroid use
- Pain that's worse when lying down
Back pain - How would you investigate this man (likely herniated disc)?
- Conservative for the first 3 weeks IF NO RED FLAG.
- Then do spinal XR +/- MRI
Back pain - Name 5 elements of management.
- Reassurance: majority settle, 10% need surg
- Pain control: heat, exercise, spine manipulation (less evidence)
- FU: GP r/v, and refer if symptomatic after 4-6 weeks
- Surgery (if severe or progressive)
Back pain - Describe the surgery for herniated disc.
- Surgery indications:
- Severe or progressive neurological deficit OR
- Leg pain > back pain, +ve straight leg raise test, no response to Tx for 4-6weeks AND imaging shows a lesion
- If indicated: discectomy or endoscopic microdiscectomy