Backache
Backache is one of the most common complaints seen in general practice and orthopaedic clinics. It accounts for about 20% of referrals to orthopaedic clinics. Most causes are either traumatic or degenerative but other causes are numerous and may occur as a result of pathology in almost any system of the body.
Causes
History
Congenital
The diagnosis is usually apparent from the history, although with spondylolisthesis, the symptoms, i.e. low lumbar backache, worse on standing, may not present until late childhood or early adult life.
Acquired
General
The speed of onset is important. Sudden onset back pain may be due to trauma or disc lesions, whereas gradual onset of pain may be due to conditions such as degenerative disease. Mechanical lesions impinging on the cord can result in neurological symptoms such as bladder dysfunction (urinary retention). Symptoms worse on movement and relieved by rest suggest a mechanical cause, whereas pain that is severe and unrelenting can occur with malignant causes. In addition, there may be symptoms (other than musculoskeletal) related to the underlying cause such as abdominal pain, dysuria or menorrhagia.
Traumatic
There will usually be a clear history of trauma. Care must be taken in moving the patient. Neurological sequelae may be obvious.
Infective
There may be a history of TB; the patient may have had night sweats or cough. Osteomyelitis of the spine may also occur in diabetes and the immunocompromised, in which case the organism is more commonly Staphylococcus aureus. With spinal TB, the patient is usually young and complains of malaise, fever, pain, tenderness and limitation of movement of the spine. Discitis usually presents with mild backache accompanied by leg pain.
