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Low Back Pain

The document summarizes the differential diagnosis of low back pain. It lists the main categories as mechanical low back or leg pain (97%), nonmechanical spinal conditions (about 1%), and visceral disease (2%). Mechanical low back pain includes conditions like lumbar strain, degenerative disk disease, herniated disks, and spinal stenosis. Nonmechanical spinal conditions include neoplasms, infections, and inflammatory diseases. Visceral diseases that can cause low back pain include diseases of the pelvic organs, kidneys, and gastrointestinal system. The document also discusses yellow flags that can cause low back pain to become chronic, as well as treatments that include medications like NSAIDs, analgesics, muscle relaxants, opioids, and drugs for

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Radja Dhilah
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151 views33 pages

Low Back Pain

The document summarizes the differential diagnosis of low back pain. It lists the main categories as mechanical low back or leg pain (97%), nonmechanical spinal conditions (about 1%), and visceral disease (2%). Mechanical low back pain includes conditions like lumbar strain, degenerative disk disease, herniated disks, and spinal stenosis. Nonmechanical spinal conditions include neoplasms, infections, and inflammatory diseases. Visceral diseases that can cause low back pain include diseases of the pelvic organs, kidneys, and gastrointestinal system. The document also discusses yellow flags that can cause low back pain to become chronic, as well as treatments that include medications like NSAIDs, analgesics, muscle relaxants, opioids, and drugs for

Uploaded by

Radja Dhilah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

LOW BACK PAIN

Residen Pembimbing :
dr. Maria Clemensia Baba
Chorda spinalis
DIFFERENTIAL DIAGNOSIS OF LOW BACK PAIN

MECHANICAL LOW BACK NONMECHANICAL SPINAL CONDITIONS


OR LEG PAIN (97%) (ABOUT 1%) VISCERAL DISEASE (2%)

Lumbar strain, sprain (70%) Neoplasia (0,7%) Disease of pelvic organs


Degenerative process of disk and facets Multiple myeloma Prostatitis
usually age-related (10%) Metastatic carcinoma Endometriosis
Herniated disk (4%) Lymphoma and leukemia Chronic pelvic inflammatory
Spinal stenosis (3%) Spinal cord tumors disease
Osteoporotic compression fracture (4%) Retroperitoneal tumors Renal disease
Spondy lolisthesis (2%) Infection (0,01%) Nephrolithiasis
Traumatic fracture (<1%) Osteomyelitis Pyelonephritis
Congenital desease (<1%) Septic diskitis Perinephric abcess
Severe kyphosis Paraspinous abcess Aortic aneurysm
Severe scoliosis Epidural abscess Gastrointestinal disease
Transitional vertebrae Shingles Pancreatitis
Spondylolysis Inflammatory arthritis (often associated Cholecystitis
Internal disk disruption or diskogenic low with HLA-B27) (0,3%) Penetrating uker
back pain Ankylosing spondylitis
Presumed instability Psoriatic spondylitis
Reiter’s syndrome
Inflammatory bowel disease
Scheuermann’s disease (osteochondrosis)
Paget’s disease of bone
Pathoanatomical
Condition of the
Lumbar Spine
(cytokines
Osteophyte Formation
Gangguan sensoris
berhubungan
dengan tingkat
cedera medula
spinalis
2. Sindroma Cauda Equina

Thoracal

Cauda
Lasseque
Lasseque menyilang
Valsava
Patrick
Manuver Contra-
Patrick
Radiologis Lumbosakral:

MRI sangat sensitive untuk diagnosis HNP


EMG (Electromiografi) dapat membedakan kelainan pada
Radiks (HNP) atau kelaianan saraf tepi
Laboratorium: Darah lengkap, LED, CRP, IGRA, Urin
lengkap bila ada kecurigaan infeksi
Kegawat Daruratan Nyeri Pinggang

Kegawat daruratan nyeri pinggang meliputi:


Cauda Equina
Cauda Equina
Cauda Equina:

Penurunan berat badan


YELLOW FLAGS
Keadaan yang membuat LBP lambat sembuh
- Postur tidur, duduk, serta aktivitas yang salah
- Faktor Psikologis: Lingkungan, pekerjaan, keluarga
- Diagnosis dan terapi yang belum tepat

Mengemudi

Bekerja

Mengangkat Barang

Bekerja

Bekerja
Yellow flags adalah faktor yang menjadi petunjuk
bagi LBP menjadi kronis
TATA
TATALAKSANA
LAKSANA
OBAT-OBATAN

(1) NON-STEROID ANTI INFLAMMATOIR DRUG (NSAID)


A. NON-SELECTIVE COX INHIBITORS
Salycilates, Ibuprofen, Indomethacin, Diclofenac, Piroxicam, Mefenamic acid
B. SELECTIVE COX-2 INHIBITORS:
Celecoxib, Etoricoxib

(2) ANALGESIC PARACETAMOL


(3) MUSCLE RELAXANT: Eperison (Myonal), Tizanidine (Sirdalud)
(4) GOLONGAN OPIOID: Tramadol
(5) OBAT NEUROPATI: Pregabalin, Gabapentin
Mild
TATA LAKSANA

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