STUDY - Technical - New Dacian's Medicine
Cervical
and Back Pain (3)
Translation Draft
Today I am "connected" on the completion of dorsolumbar pain and the transition to cervical pain. So I still have to talk about other destructive diseases with dorsolumbar incidence.
Dorsolumbar pain was the most common symptom in patients with systemic neoplasm, one-third of patients with undiagnosed dorsolumbar or cervical pain and systemic cancer with epidural extension or metastases, and one third had pain associated only with vertebral metastases, with 11% having dorsolumbar pain not bound by metastases.
Metastases of carcinomas (breast, lungs, prostate, thyroid, kidney, gastrointestinal tract), multiple myeloma and Hodkin lymphoma and non-Hodkin are malignant tumors that frequently involve the spine. Dorsolumbar pain may be the first symptom, since the site of the primary tumor may be overlooked or asymptomatic.
Pain tends to be constant, deaf, unimproved rest and accentuated at night (mechanical lumbalgia is usually improved by rest). Radiological changes are usually destructive lesions in one or several vertebral bodies without the involvement of the disc (involvement of the disc increasing the possibility of an infectious process). MRI and TC myelography are elective studies in case of suspected vertebral metastases.
Infections are another significant cause. Vertebral osteomyelitis is usually staphylococcal, but other bacteria or Koch bacillus (Pott disease) can be pathogens. In 40% of patients, a primary source of infection can be identified, most often from the urinary tract, skin or lungs, intravenous administration of medicines being a recognised risk factor.
Dorsolumbar pain exacerbated by movement and unimproved rest, the spinal sensitivity of the skin involved and the increase of VSH are the most common elements, fever is present only in a quarter of cases, and leukocytosis in a third of patients.
Conventional X-rays can highlight the narrowing of a disc space with erosions and the destruction of adjacent vertebrae, but these diagnostic changes can occur after weeks or even months. MRI is very sensitive and specific for osteomyelitis, the identification of soft tissue details is excellent. TC is also sensitive and specific and, compared to MRI, may be more easily available and better tolerated by some patients with severe dorsolumbar pain.
The vertebral epidural abscess is manifested by back pain (aggravated by movement or palpation) and fever. The patient may have root charges, which can progress to medullary compression, with local loss of sensitivity, local weakness, incontinence and paraplegia. Spinal MRI assesses the extension of the lesion, which may include several vertebrae.
Osteoporosis and osteonulosis are the next "problem" addressed. A significant loss of bone mass can occur, with or without symptoms, in many conditions, including hyperparathyroidism, chronic steroid use or immobilization.
Compression fractures occur in more than half of patients with severe osteoporosis, the only manifestation of a compression fracture may be local pain (frequently after a minimal lesion) at the toracal or lumbar level, exacerbated by movements.
Other patients may experience chest or upper back root pain, and local spinal sensitivity is common. When compression fractures are detected, the possible underlying causes and treatable risk factors for other fractures should be carefully assessed. Compression fractures over the mediotoracic region are suggestive in malignancy.
Paget's disease of the spine is easily identified as osteoporosis in routine radiological examinations and may cause dorsolumbar pain (related to the involvement of pain-sensitive structures or secondary to their anatomical distortion) or may be painless. Compression of the medullary or nerve root can occur by bone thickening of the vertebral canal or intervertebral holes.
Irradiated pain from visceral diseases (pelvic, abdominal or thoracic diseases, which cause both local and radiated pain) is due to responses from the posterior portion of the marrow segments that irritate the affected organs. Sometimes back pain can be the only sign.
In general, pelvic diseases have irradiated pain in the sacrate region, low abdominal diseases, in the lumbar region (between the second and fourth lumbar vertebrae), and upper abdominal diseases in the lower thoracic or upper lumbar spine (from the eighth toracal vertebra to the first and second lumbar vertebrae).
Local signs (pain in the palpation of the spine, spasm of the paravertebral muscles) are missing and normal movements of the spine are not accompanied by pain or cause very little pain.
Lower and upper lumbar toracala pain in abdominal diseases is represented by responses attracted by peptic ulcer or tumors of the posterior wall of the stomach or duodenum that give characteristic epigastric pain but, if they have retroperitoneal extension can also give spinal pain.
Pain can be median, paravertebral or in both places. Other characteristics of pain may provide clues to its origin. For example, dorsolumbar pain due to ulcerative disease can be triggered by the ingestion of oranges, alcohol or coffee and improved by food or antacids. Fatty foods produce more dorsolumbar pain associated with biliary diseases.
Diseases of the pancreas (pancreatitis, cysts or tumors) can cause back pain to the right of the spine (if the head of the pancreas is involved) or to the left (if the body or tail is involved). Diseases of retroperitoneal structures (hemorrhages, tumors, pyelonephritis) can cause paravertebral pain with irradiation in the lower abdomen, perineum or anterior thigh.
A formation in the iliopsoaps region frequently produces unilateral lumbar pain with irradiation to the perineum, labia and testicles. sudden onset of low back pain in a patient receiving anticoagulants raises the suspicion of retroperitoneal haemorrhage.
Isolated lumbar pain occurs in 15 to 20% of patients with ruptured aneurysm of the abdominal aorta. The classic triad with abdominal pain, shock and back pain in an elderly person occurs in less than 20% of patients. Two out of three clinical elements are present in two thirds of patients, with hypotension present in half of them. This condition has a high mortality if not treated, so it is essential to consider the possibility of a ruptured aneurysm (in an appropriate clinical context).
The diagnosis is initially omitted in a third of patients, in part because the signs and symptoms may be nonspecific. Frequent diagnostic confusions are made with nonspecific dorsolumbar pain, diverticulitis, renal colic, sepsis and myocardial infarction. A careful abdominal examination showing the presence of a pulsating formation (present in 50 to 70% of patients) is the most important element of the physical examination.
Let's now address lower back pain from lower abdominal diseases. Inflammatory diseases of the colon (colitis, diverticulitis) or colon neoplasm may cause lower abdominal pain (between the navel and the pubis) and/ or pain in the region of the mediolumbar spine.
Pain may be moodined in tape around the body. A lesion of the transverse colon or the first part of the descending colon may cause median or left flank pain, irradiated backwards at L2 - L3. diseases of the sigmoid colon may be accompanied by irradiated pain in the upper, median suprapubic or left iliac fossa.
It's the turn of the sacred pain in gynecological and urological diseases. Pelvic organs are rarely caused by low back pain, although gynecological disorders involving uterosacrate ligaments are an important cause of chronic lumbar pain.
Endometriosis or uterine carcinoma (head or cervix) can invade urosacrate ligaments, while the malposition of the uterus can cause the traction of urosacrate ligaments, the pain irradiating in the sacral region. In endometriosis, pain begins during the premenstrual period and sometimes continues with menstrual pain.
Malposition of the uterus (retroversion, descent or prolapse) can cause sacrate pain after a few hours of orthostatism. Menstrual pain can be felt in the sacrate region. It is poorly located, colicative and can irradiate to the lower limbs.
Other pelvic sources of lower back pain include neoplastic invasion of the pelvic nerves, irradiation necrosis and pregnancy. The pain caused by neoplastic nerve infiltration is typically continuous, with progressive severity and unimproved by nocturnal rest.
Radiation therapy of pelvic tumors can cause sacrate pain through late necrosis of irradiation of tissues and nerves. Lower back pain with irradiation in one or both thighs is common in the last weeks of pregnancy.
Urological causes of sacrate pain include chronic prostatitis, prostate carcinoma with vertebral metastases and kidney or ureteral disorders. Injuries to the bladder and testicles do not usually cause low back pain.
Diagnosis of metastasis of a prostate carcinoma is put through rectal cough, imaging examinations (MRI and TC) and measurement of the specific antigen of the prostate. Infection, inflammation or neoplastic kidney disease can cause ipsilateral lumbar pain, as can artery thrombosis or renal vein. Obstruction of the ureter caused by calculus can cause paravertebral lumbar pain.
Postural low back pain occurs especially in a group of patients with nonspecific chronic low back pain in whom no anatomical or pathological changes can be found, despite complete investigations. some of these patients experience diffuse, vague dorsolumbar pain after prolonged sitting or in orthostatism and relieving it at rest.
The physical examination is not relevant, except for the 'vicious position'. Imaging studies and laboratory investigations are normal. Exercises to strengthen the paravertebral and abdominal muscles are sometimes the therapeutic solution.
And to end the back pain, let's address the problems that arise from psychiatric illness. Chronic low back pain can be found in patients with compensatory hysteria, simulants, substance abuse, chronic anxiety or depression.
Many patients with chronic low back pain treated with medication or unsuccessful surgery have a history of psychiatric conditions (depression, anxiety, drug abuse) or childhood psychological trauma (psychological or sexual abuse) that precede the onset of pain. Preoperative psychiatric evaluation is used to exclude patients with significant psychiatric disorders who are at high risk for unfavorable postoperative development.
These considerations do not exclude intervention, but it is important to be certain that dorsolumbar pain in these patients is not a serious vertebral or visceral pathology, in addition to psychiatric disorders.
Today I am "connected" on the completion of dorsolumbar pain and the transition to cervical pain. So I still have to talk about other destructive diseases with dorsolumbar incidence.
Dorsolumbar pain was the most common symptom in patients with systemic neoplasm, one-third of patients with undiagnosed dorsolumbar or cervical pain and systemic cancer with epidural extension or metastases, and one third had pain associated only with vertebral metastases, with 11% having dorsolumbar pain not bound by metastases.
Metastases of carcinomas (breast, lungs, prostate, thyroid, kidney, gastrointestinal tract), multiple myeloma and Hodkin lymphoma and non-Hodkin are malignant tumors that frequently involve the spine. Dorsolumbar pain may be the first symptom, since the site of the primary tumor may be overlooked or asymptomatic.
Pain tends to be constant, deaf, unimproved rest and accentuated at night (mechanical lumbalgia is usually improved by rest). Radiological changes are usually destructive lesions in one or several vertebral bodies without the involvement of the disc (involvement of the disc increasing the possibility of an infectious process). MRI and TC myelography are elective studies in case of suspected vertebral metastases.
Infections are another significant cause. Vertebral osteomyelitis is usually staphylococcal, but other bacteria or Koch bacillus (Pott disease) can be pathogens. In 40% of patients, a primary source of infection can be identified, most often from the urinary tract, skin or lungs, intravenous administration of medicines being a recognised risk factor.
Dorsolumbar pain exacerbated by movement and unimproved rest, the spinal sensitivity of the skin involved and the increase of VSH are the most common elements, fever is present only in a quarter of cases, and leukocytosis in a third of patients.
Conventional X-rays can highlight the narrowing of a disc space with erosions and the destruction of adjacent vertebrae, but these diagnostic changes can occur after weeks or even months. MRI is very sensitive and specific for osteomyelitis, the identification of soft tissue details is excellent. TC is also sensitive and specific and, compared to MRI, may be more easily available and better tolerated by some patients with severe dorsolumbar pain.
The vertebral epidural abscess is manifested by back pain (aggravated by movement or palpation) and fever. The patient may have root charges, which can progress to medullary compression, with local loss of sensitivity, local weakness, incontinence and paraplegia. Spinal MRI assesses the extension of the lesion, which may include several vertebrae.
Osteoporosis and osteonulosis are the next "problem" addressed. A significant loss of bone mass can occur, with or without symptoms, in many conditions, including hyperparathyroidism, chronic steroid use or immobilization.
Compression fractures occur in more than half of patients with severe osteoporosis, the only manifestation of a compression fracture may be local pain (frequently after a minimal lesion) at the toracal or lumbar level, exacerbated by movements.
Other patients may experience chest or upper back root pain, and local spinal sensitivity is common. When compression fractures are detected, the possible underlying causes and treatable risk factors for other fractures should be carefully assessed. Compression fractures over the mediotoracic region are suggestive in malignancy.
Paget's disease of the spine is easily identified as osteoporosis in routine radiological examinations and may cause dorsolumbar pain (related to the involvement of pain-sensitive structures or secondary to their anatomical distortion) or may be painless. Compression of the medullary or nerve root can occur by bone thickening of the vertebral canal or intervertebral holes.
Irradiated pain from visceral diseases (pelvic, abdominal or thoracic diseases, which cause both local and radiated pain) is due to responses from the posterior portion of the marrow segments that irritate the affected organs. Sometimes back pain can be the only sign.
In general, pelvic diseases have irradiated pain in the sacrate region, low abdominal diseases, in the lumbar region (between the second and fourth lumbar vertebrae), and upper abdominal diseases in the lower thoracic or upper lumbar spine (from the eighth toracal vertebra to the first and second lumbar vertebrae).
Local signs (pain in the palpation of the spine, spasm of the paravertebral muscles) are missing and normal movements of the spine are not accompanied by pain or cause very little pain.
Lower and upper lumbar toracala pain in abdominal diseases is represented by responses attracted by peptic ulcer or tumors of the posterior wall of the stomach or duodenum that give characteristic epigastric pain but, if they have retroperitoneal extension can also give spinal pain.
Pain can be median, paravertebral or in both places. Other characteristics of pain may provide clues to its origin. For example, dorsolumbar pain due to ulcerative disease can be triggered by the ingestion of oranges, alcohol or coffee and improved by food or antacids. Fatty foods produce more dorsolumbar pain associated with biliary diseases.
Diseases of the pancreas (pancreatitis, cysts or tumors) can cause back pain to the right of the spine (if the head of the pancreas is involved) or to the left (if the body or tail is involved). Diseases of retroperitoneal structures (hemorrhages, tumors, pyelonephritis) can cause paravertebral pain with irradiation in the lower abdomen, perineum or anterior thigh.
A formation in the iliopsoaps region frequently produces unilateral lumbar pain with irradiation to the perineum, labia and testicles. sudden onset of low back pain in a patient receiving anticoagulants raises the suspicion of retroperitoneal haemorrhage.
Isolated lumbar pain occurs in 15 to 20% of patients with ruptured aneurysm of the abdominal aorta. The classic triad with abdominal pain, shock and back pain in an elderly person occurs in less than 20% of patients. Two out of three clinical elements are present in two thirds of patients, with hypotension present in half of them. This condition has a high mortality if not treated, so it is essential to consider the possibility of a ruptured aneurysm (in an appropriate clinical context).
The diagnosis is initially omitted in a third of patients, in part because the signs and symptoms may be nonspecific. Frequent diagnostic confusions are made with nonspecific dorsolumbar pain, diverticulitis, renal colic, sepsis and myocardial infarction. A careful abdominal examination showing the presence of a pulsating formation (present in 50 to 70% of patients) is the most important element of the physical examination.
Let's now address lower back pain from lower abdominal diseases. Inflammatory diseases of the colon (colitis, diverticulitis) or colon neoplasm may cause lower abdominal pain (between the navel and the pubis) and/ or pain in the region of the mediolumbar spine.
Pain may be moodined in tape around the body. A lesion of the transverse colon or the first part of the descending colon may cause median or left flank pain, irradiated backwards at L2 - L3. diseases of the sigmoid colon may be accompanied by irradiated pain in the upper, median suprapubic or left iliac fossa.
It's the turn of the sacred pain in gynecological and urological diseases. Pelvic organs are rarely caused by low back pain, although gynecological disorders involving uterosacrate ligaments are an important cause of chronic lumbar pain.
Endometriosis or uterine carcinoma (head or cervix) can invade urosacrate ligaments, while the malposition of the uterus can cause the traction of urosacrate ligaments, the pain irradiating in the sacral region. In endometriosis, pain begins during the premenstrual period and sometimes continues with menstrual pain.
Malposition of the uterus (retroversion, descent or prolapse) can cause sacrate pain after a few hours of orthostatism. Menstrual pain can be felt in the sacrate region. It is poorly located, colicative and can irradiate to the lower limbs.
Other pelvic sources of lower back pain include neoplastic invasion of the pelvic nerves, irradiation necrosis and pregnancy. The pain caused by neoplastic nerve infiltration is typically continuous, with progressive severity and unimproved by nocturnal rest.
Radiation therapy of pelvic tumors can cause sacrate pain through late necrosis of irradiation of tissues and nerves. Lower back pain with irradiation in one or both thighs is common in the last weeks of pregnancy.
Urological causes of sacrate pain include chronic prostatitis, prostate carcinoma with vertebral metastases and kidney or ureteral disorders. Injuries to the bladder and testicles do not usually cause low back pain.
Diagnosis of metastasis of a prostate carcinoma is put through rectal cough, imaging examinations (MRI and TC) and measurement of the specific antigen of the prostate. Infection, inflammation or neoplastic kidney disease can cause ipsilateral lumbar pain, as can artery thrombosis or renal vein. Obstruction of the ureter caused by calculus can cause paravertebral lumbar pain.
Postural low back pain occurs especially in a group of patients with nonspecific chronic low back pain in whom no anatomical or pathological changes can be found, despite complete investigations. some of these patients experience diffuse, vague dorsolumbar pain after prolonged sitting or in orthostatism and relieving it at rest.
The physical examination is not relevant, except for the 'vicious position'. Imaging studies and laboratory investigations are normal. Exercises to strengthen the paravertebral and abdominal muscles are sometimes the therapeutic solution.
And to end the back pain, let's address the problems that arise from psychiatric illness. Chronic low back pain can be found in patients with compensatory hysteria, simulants, substance abuse, chronic anxiety or depression.
Many patients with chronic low back pain treated with medication or unsuccessful surgery have a history of psychiatric conditions (depression, anxiety, drug abuse) or childhood psychological trauma (psychological or sexual abuse) that precede the onset of pain. Preoperative psychiatric evaluation is used to exclude patients with significant psychiatric disorders who are at high risk for unfavorable postoperative development.
These considerations do not exclude intervention, but it is important to be certain that dorsolumbar pain in these patients is not a serious vertebral or visceral pathology, in addition to psychiatric disorders.
Don't
forget that tomorrow begins the weekend with the ladies and
mothers' day of our lives and the day after tomorrow they come
upon us the mucenics!
Fun
but also Faith, Love and Gratitude...
Dorin, Merticaru