Common Lower Back Pain exam questions for medical finals, OSCEs and MRCP PACES
What are the features of inflammatory back disease?
- Insidious onset
- Onset at young age
- Worse in the morning
- Improves with exercise
What are the red flag symptoms in lower back pain?
- Patient factors
- Age <20 or >55
- Current or recent infection (especially TB, but staph and others will infect the spine)
- Immunosuppression (infection)
- Abdominal mass (malignancy)
- Acute onset in elderly (think osteoporotic fracture)
- Constant or progressive pain
- Pain at night
- Pain when supine (pain usually improves on lying flat in mechanical back problems)
- Morning stiffness
- Fever, high sweats, weight loss (malignancy)
- Thoracic back pain
- Bilateral or alternating symptoms
- Neurological abnormalities (weakness, numbness)
- Sphincter disturbance (incontinence of urine and faeces)
- Leg ‘claudication’ (? Spinal stenosis)
What are the indications for an MRI in lower back pain?
- If you are suspecting:
- Cord compression
- Cauda equina
- Acute fracture
- Inflammatory back disease
What are the common causes of cauda equina and cord compression?
- Large, central disc protrusion
- Bone metastases
- Cord or paraspinal tumour