1. Case presentation Backache Dr F Pato MBCHB (Stell)

2. Presenting history 44yr male Sudden onset backache while driving Non-radiating Unable to move as a result thereof. No neurological symptoms. First episode of such complaint. No other complaints

3. Previous history PMH: DM for 1yr, PSH: Nil Meds: Daonil Allergies: Nil Social: Smoking- alcohol- Clerical work Sedentary lifestyle,

4. Examination GCS 15/15 Height 1.68m Weight 79kg BMI 27.9 Vitals within normal limits

5. CARDIOVASCULAR – Pulses regular and equal – Cap refil <3s – No abnormalities noted – S1 S2

6. RESP No signs of distress Equal chest expansion Resonat percussion Air entry good bilaterally

7. ABDOMEN Central obesity Bowel sounds present Soft and non-tender No organomegaly palpable

8. Patient moving N0 deformities/ scars Tender over lower back NEURO Power 5/5 Tone normal Reflexes intact Sensation intact (3/3)

9. Examination cont. Assessment: – ?mechanical backache – ?muscle spasm – ?slipped vertebral disc – ?fracture

10. Managemnet X-ray Analgesia Bed rest Orthopaedics consult

15. CT scan not working MRI not available Loss of function, income, disability

16. Discussion: Backache +/- 80% Self limiting Disabling disease 75% spontaneous recovery 2-3/52 5% ends up with surgery Classified according to age group

17. Children Red flag trauma infectious conditions: discites vertebral osteomyelitis. neoplastic condition

18. Teenagers Postural Deformities Trauma Infections

19. Young adults 20-40yrs Occupation Disc lesions Ankylosing spondylitis Trauma Infective conditions Spondylolysis Spondylolisythesis

20. Older adults Degenerative conditions Scoliosis L4/L5 Spondylolisthesis 5F’s Spinal stenosis Malignancy Weight Osteoporosis Vascular

21. Other conditions Urogenital Gastrointestinal Gynaecological

22. Approach to backache Good clinical history Careful examination Well planned special examinations Management

23. Good clinical history Onset Duration Aggravating and alleviating factors Distribution Grading

24. Thorough examination Look Feel Move: flexion, extension, lateral flexion, rotation, muscle power Full neurological examination: Motor sensory (3-point scale) distribution Reflexes

25. Well planned special examinations Xrays MRI Myelography Radio isotopes Serology

26. Management Conservative vs surgery Conservative Physiotherapy Kinetic handling, mobilization, muscle balancing, symptomatic treatment Medication Work placement

27. – Surgery – Failure of conservative management – Unstable fractures – Pathological fractures – Disc herniation and root compression – Complications

28. bibliograpy Concise system of orthopaedics and fractures 2 nd edition, A G Apley. L Solomon Current surgical diagnosis and treatment 11 th edition, L W Way. GM Doherty Lecture notes, Prof JGVlok, Stellenbosch university,2005 Vlok JG, backache: a great medical problem, SA Orthopaedic Journal,Aug,2006,18-24

29. THE END!