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A Pain in the Back
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ACP Guideline Published in 2011
http://annals.org/article.aspx?articleid=746774
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Key Points
 Back pain is very common
 A selective approach to back pain imaging
is recommended
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Indications for immediate imaging
 Major risk factors for cancer as a cause
 Risk factors for spinal infection
 Evidence of cauda equina syndrome
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
Urinary retention

Fecal incontinence

Saddle anesthesia
Mr. G
 Diabetic
 Boil 3 weeks ago
 Malaise
 Tenderness L3-L4
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Epidural abscess
 Identifiable portal of entry in 2/3
 Spinal surgery
 Epidural catheter
 Skin – soft tissue infection
 Hematogenous (iv drug use)
 Classic: fever + spine tenderness + neurologic
 Most not classic
 MRI
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Consult Guys Replies
 Mr. G’s presentation suggests epidural
abscess
 An MRI should be done
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