Initial approach to patients with acute lower back pain

We present a case of a 30-year-old man who had a 3-year history of low back pain. MRI demonstrated an infiltrative mass, affecting the vertebral body and pedicles of L4, with some extension to the vertebral canal. There was also tumor invasion in the inferior vena cava and in the left iliopsoas muscle. The anatomopathological examination of the resected L4 vertebral body was of a malignant neoplasia compatible with mesenchymal chondrosarcoma (high histological grade). About 2 months after surgery, he developed a progressive bladder incontinence, bilateral leg weakness and severe back pain. A new MRI was obtained, confirming progression of the disease. An occipital scalp lesion was detected and biopsy confirmed cutaneous metastasis. Primary malignant bone tumors are rare but should be ruled out in young patients with persistent low back pain. We present a case of a confirmed mesenchymal chondrosarcoma affecting lumbar spine, with MRI and pathological illustrations. Early diagnosis may improve the chances of local disease control and even cure.

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“…New and persistent back pain of more than 3 months should be investigated preferentially with MRI. 8…”

Section: Discussionmentioning

confidence: 99%

Vertebral body chondrosarcoma with metastasis to the scalp

et al. 2019

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“…However, often no correlation is found between clinical radiological assessments and low back pain symptoms. This is true for most cases of chronic low back pain, corresponding to a clinical entity named "common mechanical low back pain" or "nonspecific low back pain" [3].…”

Section: Introductionmentioning

confidence: 97%

Chronic low back pain and sick-leave: a functional magnetic resonance study

et al. 2020

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Background: Chronic low back pain (CLBP) represents a problem in the occupational environment, often associated with disability, sick-leave demands, loss of productivity, anxiety, depression and high socioeconomic cost. The emergence of functional neuroimaging allowed new insights into brain structure and physiology in normality and chronic pain. While occupational related aspects are recognized as important risk factors for chronicity there have not been thus far evaluated by fMRI experiments. The overall objective of this study is to compare the neuronal correlates between groups of individuals CLBP with or without sick-leave demands. Methods: A total of 74 individuals were divided into three groups: chronic low back pain with sick-leave demands [CLBP_L]; chronic low back pain without sick-leave demands [CLBP_NL]; individuals without pain or sick-leave demands [Control]. Functional magnetic resonance imaging was used to assess brain function during moderate acute pain stimulation task (thumb controlled pressure). Results: After acute painful stimulation, a higher brain response was found in the anterior cingulate and superior and medium frontal gyrus was observed in CLBP_NL vs. CLBP_L (p < 0,001) and increased brain response in the frontal pole and paracingulate region in control vs. CLBP_L (p < 0.001) during acute pain stimulation. Conclusion: The modulation of acute pain participates in the mechanism propagating chronic pain perception. The lower activation in the superior frontal gyrus observed in the CLBP_L group compared to CLBP_NL, reinforces the idea of an already existing activation in this area.

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“…A dor lombar (DL) ou lombalgia é considerada um problema de saúde pública, responsável por gerar altos custos à sociedade e aos serviços de saúde, uma vez que é a principal causa de absenteísmo no Brasil e uma das principais razões de procura por atendimento médico 1,2 . Apesar do prognóstico positivo da DL, que apresenta altas taxas de resolução espontânea nas primeiras seis semanas (fase aguda), ocorre que 30% dos pacientes podem desenvolver dor lombar crônica (DLC), quando os sintomas persistem acima de doze semanas 3,4 .…”

Section: Introductionunclassified

Prevalência De Cinesiofobia E Fatores Associados Em Indivíduos Com Dor Lombar

et al. 2021

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Objetivo: Analisar a prevalência de cinesiofobia e comportamentos associados às maiores médias de cinesiofobia em indivíduos com dor lombar. Métodos: Estudo transversal, envolvendo indivíduos com diagnóstico de dor lombar que procuram atendimento fisioterapêutico vinculado ao Sistema Único de Saúde. Sendo aplicado um questionário para caracterizar a amostra. A Escala Visual Analógica para avaliar a intensidade da dor lombar e os questionários Internacional de Atividade Física e Roland Morris-Brasil para analisar o nível de atividade física e grau de incapacidade funcional. Por último, a Escala Tampa para cinesiofobia-Brasil foi aplicada para avaliar a presença e grau de cinesiofobia. Resultados: A amostra foi composta por 110 indivíduos com média de idade de 52,2 ± 12,2 anos, a maioria mulheres (74,5%). A média da intensidade da dor foi de 6,42 ± 2,26 e não houve correlação significativa entre o grau de cinesiofobia e a intensidade da dor (p=0,828 – r= -0,030). A prevalência de cinesiofobia foi de 78,2%, sendo que a maioria da amostra foi classificada com grau moderado. O escore médio de cinesiofobia foi de 45,4 ± 8,7, indivíduos sedentários (p = 0,026), com sobrepeso / obesidade (p = 0,039) e incapacidade funcional (p = 0,021) apresentaram as maiores médias de cinesiofobia. Considerações Finais: A prevalência de cinesiofobia é alta em indivíduos com dor lombar que procuram atendimento fisioterapêutico, estando associada ao nível de atividade física, incapacidade funcional e índice de massa corporal. Nível de Evidência II – Estudo Retrospectivo.

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Initial approach to patients with acute lower back pain

Cited by 8 publications

References 17 publications

Vertebral body chondrosarcoma with metastasis to the scalp

Vertebral body chondrosarcoma with metastasis to the scalp

Chronic low back pain and sick-leave: a functional magnetic resonance study

Prevalência De Cinesiofobia E Fatores Associados Em Indivíduos Com Dor Lombar

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