Back pain
- no evidence that adding diazepam to NSAIDs aids recovery from non-traumatic low back pain (Annals Emerg Med 2020 - Diazepam in back pain)
| Red flags | |
|---|---|
| T | Trauma |
| U | Unexplained LOW |
| N | Neurological symptoms |
| A | Age > 50yr |
| F | Fever |
| I | IVDU |
| S | Steroid use |
| H | Hx of cancer eg. prostate, breast, lung, renal |
Spondylolisthesis
Wiltse et al. categorized spondylolisthesis into 5 types based on etiology but is more of a descriptive classification and does not generally aid Mx
- Type I - congenital dysplasia with doming of the S1 vertebra, allowing the L5 vertebra to slip anteriorly.
- Type II, or isthmic - stress fractures in the pars interarticularis and occurs most frequently in children.
- Type III is degenerative, occurs in older people, and is caused by degenerative changes as a result of stress loading, leading to anterior slip.
- Type IV, traumatic - trauma cause.
- Type V is pathologic fracture of the pars
Meyerding classification based on degree of slip and makes use of pain lateral film:
- Grade I - <25%
- Grade II - 25-50%
- Grade III- 50-75%
- Grade IV - 75-100%
- Grade V - >100 (spondyloptosis)
In general, Grade I, II are largely asymptomatic but respond to conservative Mx mostly. Various opinions about best surgical approach to those that do not respond or slippage progresses - eg fusion and/or decompression
Clinical Ortho 2020. review spondylolisthesis