Outline for discussion: I. Differential Diagnosis of life (or limb) -threatening back pain and clues to presentation: A. Dissecting aortic aneurysm (h/o male sex, advanced age, chronic hypertension, connective tissue syndromes, decelerating trauma, aortitis, cocaine use).
B. Cauda equina syndrome (disc herniation below termination of spinal cord – can have h/o arthritis or injury)
C. Vertebral osteomyelitis/epidural abscess (IVDU, recent procedure, fever)
D. AAA rupture (male sex, advanced age, hypertension, tobacco use, family h/o).
E. Spinal metastasis of underlying malignancy (h/o breast, prostate, lung, kidney, or thyroid cancer; insidious onset, awakens at night, weight loss).
F. Epidural hematoma (recent procedure, anticoagulated, trauma).
G. Spinal cord compression from large disc herniation (h/o trauma/injury)
H. Vertebral fracture with potential spine instability (h/o trauma/malignancy/compression fractures, osteoporosis).
II. History: Pain – location, duration, radiation, presence at night, severity, what exacerbates it, what relieves it, any sensory deficits or muscle weakness noted, any bowel/bladder dysfunction?
“Red Flags” in history:
A. IVDU or recent procedure that could cause bacteremia