Presented by: Dr Paul Licina - Spine Surgeon Event: Compensation and the Spine - 2016

1. acute LBP ≠ chronic LBP
LOW BACK PAIN
• acute tissue trauma
• self-limiting
• stay active, be positive
• dysfunction in nervous system
• long-lasting
• multidisciplinary interventions
genetic
psychosocial

2. What causes
back pain ? SEGMENTAL INSTABILITY
DISCOGENIC PAIN
FACETOGENIC PAIN
SOFT-TISSUE RELATED
UNKNOWN CAUSE
CHRONIC LOW BACK PAIN

3. SEGMENTAL INSTABILITY
DISCOGENIC PAIN
FACETOGENIC PAIN
SOFT TISSUE/
UNKNOWN
CAUSE
CHRONIC LOW BACK PAIN
What causes
back pain ?

4. DISEASE DIAGNOSIS
symptoms and signs
Hx, Ex & Ix
TREATMENTCURE
directed at pathology
THE MEDICAL MODEL

5. DISEASE DIAGNOSIS
symptoms and signs
Hx, Ex & Ix
functional overlay
15%normal degenerative process
vs pathology
not discrete illness
THE MEDICAL MODEL

6. USUAL
NONOPERATIVE
TREATMENTS
GENERALLY
INEFFECTIVE
CHRONIC LOW BACK PAIN
multidisciplinary approach

7. SEGMENTAL INSTABILITY
DISCOGENIC PAIN
FACETOGENIC PAIN
SOFT TISSUE/
UNKNOWN
CAUSE
CHRONIC LOW BACK PAIN
What can we
treat
surgically ?

8. DECISION
WHETHER TO
OPERATE IS
DIFFICULT
surgery is not universally effective
DEGENERATION
DOES NOT ALWAYS
EQUAL PAIN
incidence of degenerative changes on x-ray
back pain population = normal population
CHRONIC LOW BACK PAIN

10. • 38 year old female
• 18/12 of worsening low back pain
• Conservative treatment for past year
• Simple analgesics
• Flares of back pain becoming more frequent
• Fit, active lifestyle
• Recently ceased running and regular sport
• Working but with difficulty
• No WorkCover/legal claim
• Mild restriction of forward flexion
• Normal neurological examination

15. • 76 y.o. retired farmer
• Long history of mild backache
• Recent change with sharp, catching left-
sided back pain
• Vague leg discomfort causing no
functional limitations
• Tender left low back
• Pain on hyperextension
• No neurological deficit

22. • 32 year old manual worker
• Sudden back pain with repetitive lifting
• Off work since injury, 9 months ago
• WorkCoverclaim, considering litigation
• High narcotic intake
• Spends majority of time in bed, resting
• Very restricted ROM in all directions
• Marked abnormal illness behaviour