Nonspecific Low Back Pain (LBP) can occult a serious pathology: Case report of Multiple Sclerosis (MS) in a young patient

Maselli, Filippo; Pennella, Denis; Cataldi, Fabio; Davide, Albertoni Bruno; Ciuro, Aldo

doi:10.5530/ami.2016.1.40

Cited by 4 publications

(1 citation statement)

References 7 publications

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“…The ability to perform an adequate screening of the patient and to recognize such pathologies is a key component of the physiotherapist’s practice [ 27 , 28 ], especially in the path of direct access to treatment. Differential diagnosis in PT practice is the result of a complex process of clinical reasoning and decision making, which integrates information from the patient’s history, physical examination and imaging findings, when available [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Aggressive Vertebral Hemangioma and Spinal Cord Compression: A Particular Direct Access Case of Low Back Pain to Be Managed—A Case Report

Brindisino

Scrimitore

Pennella

et al. 2022

IJERPH

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Hemangiomas are the most common benign tumours affecting the spine, with an incidence of 10–12% of the general population. Although most hemangiomas are asymptomatic, there are aggressive forms which can develop symptoms, leading patients to show signs of disability. This case report aims to highlight the importance of red flags screening, and to report the physiotherapist’s clinical reasoning that led him to refer his patient to other healthcare professionals. This case also illustrated the pre- and post-surgical treatment of a specific low back pain case in a patient affected by aggressive vertebral hemangioma and spinal cord compression. The patient is a 52-year-old man, who reported intense pain in his sacral region about three months prior, which worsened while in sitting position. The physiotherapist proceeded with a complete medical history investigation and clinical examination. After an impaired neurological examination, the patient was referred to another health professional, who diagnosed multiple vertebral hemangiomas in the patient’s lumbosacral tract. The therapeutic intervention included the patient’s post-surgical rehabilitation following a vascular embolization. This case report shows the importance of proper patient screening. Indeed, during patients’ assessment, it is paramount to recognize red flags and to investigate them appropriately. An early referral of patients with conditions that require the support and expertise of other professionals can lead to a timely diagnosis and avoid costly and unnecessary rehabilitation procedures. In this case, the interdisciplinary collaboration between physiotherapist and neurosurgeon was crucial in guiding the patient towards recovery.

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Section: Discussionmentioning

confidence: 99%

Aggressive Vertebral Hemangioma and Spinal Cord Compression: A Particular Direct Access Case of Low Back Pain to Be Managed—A Case Report

Brindisino

Scrimitore

Pennella

et al. 2022

IJERPH

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Neoplastic malignant cord compression mimicking low back pain: A case report

Cataldi

Brindisino

Angilecchia

et al. 2022

Physiotherapy Res Intl

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Background:The point prevalence of Cauda Equina Syndrome (CES) as a cause of Low Back Pain (LBP) is estimated at 0.04% in primary care, and it is reported as a complication in about 2% of patients with disc herniation. Compression of the cauda equina usually occurs as a result of disc prolapse. However, CES may be caused by any space-occupying lesion, including spinal stenosis, neoplasms, cysts, infection, and osteophytes. First contact physiotherapists may encounter patients with early CES, as the clinical presentation of CES can mimic non-specific LBP.Case presentation: This case report presents the medical history, diagnostic tests and relevant clinical data of a 52-year-old man complaining of LBP. The patient's medical history, his symptoms and the clinical findings led to the identification of a number of red flags (i.e. risk factors) suggestive of a non-musculoskeletal condition.The patient was referred to the emergency department for further investigation.Having undergone several diagnostic tests, the patient was diagnosed with CES due to malignancy. Conclusions:This case report highlights the importance of differential screening throughout the treatment period, in order to identify red flags that warrant further investigation and a referral to an appropriate specialist. Physiotherapy screening should include clinical reasoning, careful analysis of clinical presentation and symptom progression, in addition to appropriate referral for medical assessment and diagnostic imaging, if necessary. K E Y W O R D Scauda equina syndrome, differential diagnosis, low back pain, malignancy, physiotherapy | BACKGROUNDLow Back Pain (LBP) is a common condition, affecting 50%-80% of adults in their lifetime (Hoy et al., 2014;Koes et al., 2010;Oliveira & Maher, 2018). It has recently been identified as the most important cause of disability (Mesner et al., 2016) and remains a common condition among primary care patients, with an estimated lifetime prevalence of 13.8% for chronic pain and 80% for any episode of pain (Verhagen et al., 2016).European guidelines on the management of LBP in primary care define LBP as ''pain and discomfort localized below the costal margin and above the inferior gluteal folds, with or without leg pain'' (van Tulder et al., 2006). Non-specific LBP, commonly defined as LBP without any known cause (van Tulder et al., 2006), is diagnosed in about 90% of cases, due to unidentifiable underlying musculoskeletal causes (Fatoye et al., 2019;Koes et al., 2010;Oliveira & Maher, 2018). Patients with LBP may have neurological impairments, such as radiculopathy and neurological disorders, or a serious

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Hip bone marrow edema presenting as low back pain: a case report

Mourad

Maselli

Cataldi

et al. 2018

Physiotherapy Theory and Practice

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This case report highlights the importance of including a comprehensive and continuous differential diagnostic process throughout the treatment period, looking for those risk factors (i.e. red flags) that warrant further investigation and referral to the appropriate physician. Physiotherapy diagnosis should include clinical reasoning, clinical presentation, and symptom behavior in addition to appropriate referral for medical assessment and diagnostic imaging when appropriate. Physiotherapists working within a direct access environment have the competence and responsibility to participate with other health professionals in the differential diagnose process especially for patients presenting with serious pathology mimicking musculoskeletal disorders.

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Nonspecific Low Back Pain (LBP) can occult a serious pathology: Case report of Multiple Sclerosis (MS) in a young patient

Cited by 4 publications

References 7 publications

Aggressive Vertebral Hemangioma and Spinal Cord Compression: A Particular Direct Access Case of Low Back Pain to Be Managed—A Case Report

Aggressive Vertebral Hemangioma and Spinal Cord Compression: A Particular Direct Access Case of Low Back Pain to Be Managed—A Case Report

Neoplastic malignant cord compression mimicking low back pain: A case report

Hip bone marrow edema presenting as low back pain: a case report

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