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Licina low back pain

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Veröffentlicht am

Presented by:
Dr Paul Licina - Spine Surgeon

Event:
Compensation and the Spine - 2016

Veröffentlicht in: Gesundheit & Medizin
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Licina low back pain

  1. 1. acute LBP ≠ chronic LBP LOW BACK PAIN • acute tissue trauma • self-limiting • stay active, be positive • dysfunction in nervous system • long-lasting • multidisciplinary interventions genetic psychosocial
  2. 2. What causes back pain ? SEGMENTAL INSTABILITY DISCOGENIC PAIN FACETOGENIC PAIN SOFT-TISSUE RELATED UNKNOWN CAUSE CHRONIC LOW BACK PAIN
  3. 3. SEGMENTAL INSTABILITY DISCOGENIC PAIN FACETOGENIC PAIN SOFT TISSUE/ UNKNOWN CAUSE CHRONIC LOW BACK PAIN What causes back pain ?
  4. 4. DISEASE DIAGNOSIS symptoms and signs Hx, Ex & Ix TREATMENTCURE directed at pathology THE MEDICAL MODEL
  5. 5. DISEASE DIAGNOSIS symptoms and signs Hx, Ex & Ix functional overlay 15%normal degenerative process vs pathology not discrete illness THE MEDICAL MODEL
  6. 6. USUAL NONOPERATIVE TREATMENTS GENERALLY INEFFECTIVE CHRONIC LOW BACK PAIN multidisciplinary approach
  7. 7. SEGMENTAL INSTABILITY DISCOGENIC PAIN FACETOGENIC PAIN SOFT TISSUE/ UNKNOWN CAUSE CHRONIC LOW BACK PAIN What can we treat surgically ?
  8. 8. DECISION WHETHER TO OPERATE IS DIFFICULT surgery is not universally effective DEGENERATION DOES NOT ALWAYS EQUAL PAIN incidence of degenerative changes on x-ray back pain population = normal population CHRONIC LOW BACK PAIN
  9. 9. • 38 year old female • 18/12 of worsening low back pain • Conservative treatment for past year • Simple analgesics • Flares of back pain becoming more frequent • Fit, active lifestyle • Recently ceased running and regular sport • Working but with difficulty • No WorkCover/legal claim • Mild restriction of forward flexion • Normal neurological examination
  10. 10. • 76 y.o. retired farmer • Long history of mild backache • Recent change with sharp, catching left- sided back pain • Vague leg discomfort causing no functional limitations • Tender left low back • Pain on hyperextension • No neurological deficit
  11. 11. • 32 year old manual worker • Sudden back pain with repetitive lifting • Off work since injury, 9 months ago • WorkCoverclaim, considering litigation • High narcotic intake • Spends majority of time in bed, resting • Very restricted ROM in all directions • Marked abnormal illness behaviour

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