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Practical neurology - 3: Back pain and leg weakness
Timothy J Kleinig1, Brian P Brophy, Chris G Maher
1Royal Adelaide Hospital, Adelaide, SA. timothy.kleinig@health.sa.gov.au
The Medical Journal of Australia
|October 19, 2011
Summary
Back pain affects 25% of people and is a common reason for doctor visits. While most cases resolve in weeks, recurrence is frequent, and long-term benefits of invasive treatments remain unclear.
Area of Science:
- Orthopedics
- Neurology
- General Practice
Background:
- Back pain is highly prevalent, affecting 25% of the population.
- It is the third most frequent reason for consultations in Australian general practice.
- A detailed patient history and physical examination are crucial for identifying patients needing urgent investigations.
Observation:
- Radiological investigations can reveal abnormalities at multiple spinal levels.
- However, imaging cannot definitively pinpoint the primary source of a patient's back pain symptoms.
- Clinical and radiological findings require careful correlation, especially with neurological deficits.
Findings:
- Conservative treatment is recommended, even for patients with radiculopathy.
- Most acute back pain episodes resolve within 6-12 weeks.
- A significant proportion (at least one-third) experience recurrent episodes within a year.
Implications:
- While invasive procedures like steroid injections or discectomy may offer short-term relief for radiculopathy, their long-term efficacy is not well-established.
- Further research is needed to clarify the long-term benefits of invasive treatments for back pain.
- Emphasizes the importance of conservative management and careful diagnostic correlation in back pain cases.
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