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DR. BHARAT PATEL

DR. BHARAT PATEL. Jo i nt Rep l acement Surgeon. Introduction. Haldemann (1977) 26 causes Whyke (1976) 20 categories. BACK ACHE. DR.BHARAT PATEL M.S.(Ortho) SAMVED HOSPITAL. Introduction. Hazleman and Bulgar (1979) Disc prolapse over diagnosed. Introduction.

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DR. BHARAT PATEL

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  1. DR. BHARAT PATEL Jo i nt Rep l acement Surgeon

  2. Introduction • Haldemann (1977) 26 causes • Whyke (1976) 20 categories

  3. BACK ACHE DR.BHARAT PATEL M.S.(Ortho) SAMVED HOSPITAL

  4. Introduction • Hazleman and Bulgar (1979) Disc prolapse over diagnosed

  5. Introduction • Moorey and Robertson Benign lumbar pain syndromes

  6. Classification of low back pain • Spondylogenic back pain • Neurogenic back pain • Viserogenic back pain • Vascular back pain • Psychogenic back pain

  7. CAUSES OF BACK PAIN

  8. Causes of back pain • Poor Posture • Disturbed normal “natural S” shape of spine leads to back pain.

  9. Causes of back pain • Out of Shape • Your overall physical condition can affect your back.

  10. Causes of back pain • Tension and Stress

  11. Causes of back pain • Aging and Disease • Loss of muscle strength with aging. • “slip disc” • Osteoarthritis, a form of aging arthritis, can cause back pain.

  12. Causes of back pain • Impact Trauma

  13. Causes of back pain • Obesity

  14. Causes of back pain

  15. Adolescent acute back • 12 to 14 yrs in girls • 14 to 16 in boys • Disc space infection • Herniated lumbar disc • Spondylolysis or lysthesis

  16. Lumbar Instability • The tall young man • House wife • Post surgical patient • The keep-fit enthusiast • Young man in his 20’s with undetected lumbar osteochondrosis. • Mature woman between 40-50 with degenerative spondylolisthesis.

  17. The man fearful of his back • Over 40 and in past years suffered probably a minor episode of back pain. • Because of this temperament, combined at the time with a strongly worded caution from his doctor to take care, the patient has lost all confidence in the health and durability of the low back.

  18. Time dependent back ache • Particular movement aggravates the pain. • Particular time aggravates pain – rising in the morning.

  19. Over stressed labourers back • Strong solidly built man • Farmer • No sciatica • Insidious onset

  20. The Equinox Syndrome • Severe leg pain limb cold • Feel of numbness • Unless the neurological involvement is multiradicular, normal muscle power regained in 10 wks.

  21. Spinal stenosis • Congenital stenosis. • Acquired stenosis – facet joint arthrosis, ligamentum flavum thickening, disc trespass, posterior vertebral lipping, spondylolisthesis, venous congestion, isolated disc resorption, degenerative stenosis, disc prolapse.

  22. Chair bound back ache • 40 year old physically active in the past, but risen professionally to assume responsibility which entail much administrative work. • Obese. • Lumbar stiffness on rising in the morning.

  23. Low back pain in pregnant women • 50% of the pregnant women. • Sweden is the highest 70% (9 wks of sick leave). • Common with multiparus women. Mechanism : • Increased lumbar lordosis. • Hormone relaxing.

  24. How to prevent by exercise programme • Before pregnancy & during 1st trimester. • Can be continued in 2nd and 3rd trimester.

  25. Low back pain in children • Rare complaint. • Often illusive – Delayed diagnosis because of rarity. • Must be investigated. Causes : • Mechanical • Developmental • Inflammatory • Neoplastic • Tethered cord • Psychogenic

  26. Sports related low back ache

  27. Collapsed back with kissing spine • Women in late middle age • Lumbar ache on standing • Degenerated all joints

  28. DISORDERS OF IV DISC

  29. Backache Leads To…… • Pain • Disability to pursue activities of daily leaving • Absenteeism • Sexual dysfunction • Financial and psychological set back

  30. Diagnosis of back pain • Physical Examination & • Investigations

  31. Diagnosis of back pain • Physical Examination

  32. Diagnosis of back pain Investigation : • Blood Ix • Radiological Ix - Plain X-ray - Myelography - CT scan - MRI

  33. Management of back pain • Conservative Treatment • Operative Treatment • Preventive Treatment

  34. Conservative treatment • Medicines • Pain killers • Muscle relaxants • Vitamins

  35. Conservative treatment • Bed rest

  36. Conservative treatment • Physiotherapy • Activity modification

  37. Conservative treatment • Manipulation of back

  38. Conservative treatment • Orthosis- (belts)

  39. Conservative treatment • Weight reduction

  40. Conservative treatment • Injection therapy ( epidural steroids)

  41. Operative treatment

  42. Operative treatment WHY WHEN ? ? WHERE ?

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