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Low Back Pain in the Adult: Radiographic Studies

- Discussion:
    - plain radiographs:
           - in low risk patients, radiographs are indicated if LBP does not improve after 6 weeks;
                  - low risk implies that the patient is between 18-50 years, acute onset, absence of night pain, no recent wt loss, 
                         no neurologic symptoms;
           - radiographs are helpful in diagnosing spondylosis or spondylolithesis, and destructive lesions (from tumor; or infection);
    - dynamic radiographs:
           - normal anterior and posterior translation from L1 to L5 is about 8% of length of vertebral body or about 3-4 mm;
    - radiographic findings: (not necessarily indicative of pain)
           - Schmorl's nodes
           - spina bifida occulta;
           - lumbarization;
           - sacralization;
           - scoliosis;
           - lordosis;
           - osteophytes and spurs:
                  - traction osteophytes (associated w/ instability)
                  - marginal syndesmophytes: (AS, Inflammortory bowel disease);
                  - non marginal syndesmophytes: (DISH, Reiters and Psoriasis)
           - age related changes may include:
                  - loss of disk height
                  - vaccum phenomenon (loss of disc height leads to facet joint loading);
                  - end plate sclerosis
                  - facet arthropathy;
    - relative indications: (for ordering x-rays in patients w/ back pain)
           - age greater than 50 yrs;
           - history of cancer;
           - temp greater than 38;
           - nerve deficit;
           - recent wt loss;
           - pain at rest;
    - references:
           - Spine radiographs in patients with low-back pain. An epidemiological study in men.

- Bone Scan:
    - may help rule out infection or occult metastatic tumor;

- CT Myelogram:
    - allows accurate assesment of lumbar stensosis;
    - can detect far lateral disc herniation;

- MRI of Spine:

Electrophysiologic mapping of the segmental anatomy of the muscles of the lower extremity.

Recognizing specific characteristics of nonspecific low back pain.

Advances in low-back pain.

Predictors of low back pain disability.                                    

Predicting disability from low back pain.

The facet syndrome. Myth or reality

Medical Progress: Back Pain And Sciatica.

Back pain and sciatica.