Wednesday, July 23, 2008

Few points on diagnosis of spinal pain

Most spinal conditions are benign and self-limiting. For diagnosis the following are used: history, physical examination, and special studies, including diagnostic imaging, diagnostic blocks, and facet and sacroiliac joint injections.
1. In general, there is much more evidence on diagnostic procedures for the low back than there is for the neck.
2. With regard to the history, a number of factors can be identified which can assist the clinician in identifying sciatica due to disc herniation or serious pathology. With regard to the physical examination, the straight-leg raise is the only sign consistently reported to be sensitive for sciatica due to disc herniation, but is limited by its low specificity.
3. The diagnostic accuracy of other neurological signs and tests is unclear.
4. Orthopaedic tests of the neck, such as Spurling's or the upper-limb tension test, are useful to rule a radiculopathy in or rule out, respectively.
5. In patients 50 years of age or older, plain spinal radiography together with standard laboratory tests are highly accurate in identifying underlying systemic disease; however, plain spinal radiography is not a valuable tool for non-specific neck or low-back pain.

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