TAILIEUCHUNG - Chapter 016. Back and Neck Pain (Part 9)

Neoplasms (See also Chap. 374) Back pain is the most common neurologic symptom in patients with systemic cancer and may be the presenting symptom. The cause is usually vertebral metastases. Metastatic carcinoma (breast, lung, prostate, thyroid, kidney, gastrointestinal tract), multiple myeloma, and non-Hodgkin's and Hodgkin's lymphomas frequently involve the spine. Cancer-related back pain tends to be constant, dull, unrelieved by rest, and worse at night. By contrast, mechanical low back pain usually improves with rest. Plain x-rays may or may not show destructive lesions in one or several vertebral bodies without disk space involvement. MRI, CT, and CT-myelography are the. | Chapter 016. Back and Neck Pain Part 9 Neoplasms See also Chap. 374 Back pain is the most common neurologic symptom in patients with systemic cancer and may be the presenting symptom. The cause is usually vertebral metastases. Metastatic carcinoma breast lung prostate thyroid kidney gastrointestinal tract multiple myeloma and non-Hodgkin s and Hodgkin s lymphomas frequently involve the spine. Cancer-related back pain tends to be constant dull unrelieved by rest and worse at night. By contrast mechanical low back pain usually improves with rest. Plain x-rays may or may not show destructive lesions in one or several vertebral bodies without disk space involvement. MRI CT and CT-myelography are the studies of choice when spinal metastasis is suspected. MRI is preferred but the most rapidly available procedure is best because the patient s condition may worsen quickly. Fewer than 5 of patients who are nonambulatory at the time of diagnosis ever regain the ability to walk thus early diagnosis is crucial. Infections Inflammation Vertebral osteomyelitis is usually caused by staphylococci but other bacteria or tuberculosis Pott s disease may be responsible. The primary source of infection is usually the urinary tract skin or lungs. Intravenous drug use is a well-recognized risk factor. Whenever pyogenic osteomyelitis is found the possibility of bacterial endocarditis should be considered. Back pain exacerbated by motion and unrelieved by rest spine tenderness over the involved spine segment and an elevated ESR are the most common findings in vertebral osteomyelitis. Fever or an elevated white blood cell count is found in a minority of patients. Plain radiographs may show a narrowed disk space with erosion of adjacent vertebrae however these diagnostic changes may take weeks or months to appear. MRI and CT are sensitive and specific for osteomyelitis CT may be more readily available in emergency settings and better tolerated by some patients with severe back pain. Spinal .

• Y học thường thức
• Back and Neck Pain
• bệnh học và điều trị
• bài giảng bệnh học
• tài liệu học ngành y
• Harrisons Internal Medicine
• BMC Musculoskeletal Disorders
• Neck pain
• Low back pain
• Concomitant neck
• Spinal pain
• Musculoskeletal pain
• Serial cross sectional design
• Neck and shoulder pain
• Back pain
• Body composition
• General population
• Primary care
• Psychological factors
• Population based study
• Ural eye
• Thoracic spine pain
• Appropriateness of care
• Spinal mobilization
• Spinal manipulation
• Chronic low back pain
• Chronic neck pain
• Patient preferences
• Treatment response
• Treatment disability
• Fear avoidance beliefs
• Work disability
• Return to work
• Brief intervention
• Proprioceptive training
• Systematic review
• Chiropractic care
• Visit frequency
• Behavioral model of health services use
• Muskuloskeletal manipulations
• Sports club participation
• Health promotion
• Fear–avoidance beliefs
• Psychosocial work factor
• 7 Steps to a Pain
• health education
• health knowledge
• health
• health care
• medical research