Back pain

The aim of this topic is to alert you to the wide differential diagnosis of back pain (an extremely common symptom). In particular you should become familiar with the pathological processes that may induce back pain and the investigations that can establish the diagnosis.

Learning objectives:

At the completion of this topic you should be able to:

1. List the common sources of back pain, both somatic and visceral.
2. Distinguish between the classical clinical features of mechanical and inflammatory back pain.
3. Outline the pathogenesis of lumbar intervertebral disc degeneration and prolapse, and describe the clinical syndromes that may ensue.
4. Define the terms "spondylolisthesis" and "facet joint degeneration", and explain how these disorders may cause back pain.
5. Compare and contrast the clinical features of acute osteomyelitis in children and adults.
6. Describe the complications of vertebral osteomyelitis, both pyogenic and tuberculous.
7. Explain the pathophysiology of metabolic bone diseases - in particular osteoporosis (primary and secondary), osteomalacia, hyperparathyroidism, Paget disease of bone and renal osteodystrophy.
8. Construct a table comparing the biochemical and radiographic abnormalities caused by each of the metabolic bone diseases.
9. Discuss the methods of prevention and the investigation of post-menopausal osteoporosis.

1. Discuss the following statement: "The clinical effects of renal osteodystrophy result from a combination of osteoporosis, osteomalacia, hyperparathyroidism and iatrogenic factors."
2. Write brief notes on lumbar disc prolapse.
3. Write brief notes on Paget disease and its complications.

Other relevant protocols - 39, 41

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