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Old 09-29-2011
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Default back pain, which is the best initial investigation

i had got a fair concept unless i went through a uworld question.
1)for somebody with positive straight leg raising test, we go for analgesics and observation n MRI only if it persists or neurological deficit develops
2)for somebody with acute onset neurologicall deficit alongwith back pain its MRI to be done next
3)for somebody with contant pain for a couple of months, worse at night, unresponsive to analgesics along with weight loss what is d next best step
MRI or Xray, uworld says its xray and at the same tym advises MRI for those with high suspicion of mets or epidural abscess.
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Old 09-29-2011
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Quote:
Originally Posted by amberafzal View Post
i had got a fair concept unless i went through a uworld question.
1)for somebody with positive straight leg raising test, we go for analgesics and observation n MRI only if it persists or neurological deficit develops
2)for somebody with acute onset neurologicall deficit alongwith back pain its MRI to be done next
3)for somebody with contant pain for a couple of months, worse at night, unresponsive to analgesics along with weight loss what is d next best step
MRI or Xray, uworld says its xray and at the same tym advises MRI for those with high suspicion of mets or epidural abscess.
Most metasteses can be seen on simple x-ray, so that's first step. If hte vignette says something about fever, IV drug user or similar, go for MRI to exclude osteomyelitis or epidural abscess or similar.
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Old 09-29-2011
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Quote:
Originally Posted by amberafzal View Post
i had got a fair concept unless i went through a uworld question.
1)for somebody with positive straight leg raising test, we go for analgesics and observation n MRI only if it persists or neurological deficit develops
2)for somebody with acute onset neurologicall deficit alongwith back pain its MRI to be done next
3)for somebody with contant pain for a couple of months, worse at night, unresponsive to analgesics along with weight loss what is d next best step
MRI or Xray, uworld says its xray and at the same tym advises MRI for those with high suspicion of mets or epidural abscess.
According to kaplan, isotope bone scan is the best next step if bone metastasis is highly suspicious. It can be followed by X-ray. The rationale behind is

'isotope bone scan is the most sensitive test for bone mets, but not specific".

In my clinical practice, I go ahead with X ray as the first step....it's quick and cheap...

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Old 09-29-2011
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Bone scan is obsolete now, its only indication is when u cannot perform an MRI.
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Old 09-30-2011
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To answer your Q,if you suspect malignancy (low back pain for couple of months & wt loss) according to kaplan, it is MRI, b/c X ray will show the met if it is advance disease & bone scan is nonspecific although sensitive.
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