Low back pain and radiculopathy in a rheumatology clinic: a clinical and radiological audit

Abstract

Background: Back pain is mostly mechanical in aetiology. Low back pain (LBP) has been reported at various times as a non-specific health problem and a general complaint among people of all ages with severe effect and complaint among the middle aged and the elderly. It is more often reported in developed than in the developing countries and has been reported as a major economic disease burden and cause of hospital visits, work absenteeism and disability. Aim and Objective: To determine the clinical and radiological patterns of Low back pain among patients attending a private practice rheumatology clinic over a five-year period (2009-2013) Method: This was a retrospective audit of subjects presenting with low back pain at a private practice rheumatology clinic. Diagnoses were made following detailed history, physical examination as the patients presented. Imaging studies were done as required. Management was with standard medications and physiotherapy. Treatment modalities were with Analgesics-narcotics and NSAIDs, neuromodulators, muscle relaxants in different combinations. Eight patients (2.5% of total) were referred for surgery. Results: 316 patients presented with low back pain and/or features of radiculopathy with duration of symptoms prior to presentation between 16 -96 weeks with a mean (±SD) of 34(±1.4) weeks. Low back pain and paraesthesia/neuropathic pain were the main complaints at presentation. The findings on physical examination showed that most patients had positive femoral nerve stretch test, accounting for 44% of total and suggesting an upper lumbar spine nerve root compression. Straight leg raising test was positive in 25% of patients and FABER in 19.3% of patients. Lumbosacral spondylosis was the commonest aetiology and accounted for 70% of total cases. Back pain from spinal canal stenosis was the least accounting for 2.9% of total presentation.