Can't Miss Back Pain Diagnoses
Thu, 04/01/2021 - 6:00am
- Patient had normal basic labs & inflammatory markers and was discharged with return precautions and outpatient follow up.
- Patient was diagnosed with OSTEOMYELITIS.
- Construction worker presents with low back pain
- Rectal tone intact
- Tachy afebrile (129 bpm temp 98.8F)
- Repeat visit a couple days later non-focal neuro exam but did have murmur on exam (since childhood)
- Diaphoretic à febrile via RECTAL TEMPERATURE to 102
- endocarditis with abscess and severe regurgitation
- Also had T12/L1 facet joint infection
- Patient with history of chronic back pain presenting with lower back pain, radiates to BLE
- No fevers, hx IVDU when he runs out of pain meds for 3 weeks; similar to prior episodes
- No IVDU recently, snorted 4 days prior
- No weakness, numbness, incontinence, or fevers
- Given oxy, lido patch and PMD follow up
- Fall, normal vitals including temp
- Rectal temp obtained 101.5
- Finally admits to IVDU
- Paresthesias of BLE and weakness (4/5 BLE, +rectal tone)
- MRI: T8/T9 osteo with epidural abscess went to OR for decompression
WHO DO WE SEARCH FOR THESE BAD SPINAL INFECTIONS AND BACK PAINS?
- IVDU à trust but verify
- Indwelling catheters (PICC, port) àhematogenous bacterial spread
- Concomitant soft tissue infections
- Instrumentation near spine
- Only about ¼ will have weakness or numbness
- WBC normal in ½, afebrile or fluctuating temp in about ½, ESR normal in 5-10%
- Usually JUST have back pain!! Then gets paresthesias with compression and can progress rapidly over hours to days
- Months of pain = NOT protective
- Early dx is essential bc neuro deficits on presentation are usually irreversible
So how do you work them up?
- MRI the area above and below pain!!