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| ==Background==
| | #REDIRECT[[Lower back pain]] |
| *If no [[Cauda equina syndrome]] or progressive neuro deficit → delay surgery for a month
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| *Epidural steroids for temporary symptomatic relief
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| *Discetomy gives better pain control over 4 yrs but not past 10
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| *Microdiscectomy similar to standard discectomy but percutaneous or laser discetomy less effective than standard surgery
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| ==Spinal Stenosis==
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| *Low back pain that gets progressively worse over time
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| **Check ankle-brachial index (ABI) to rule out vascular claudication
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| *Avoid alcohol and strengthen legs to prevent falls
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| *Exercise bike or walking recommended with rest when pain comes
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| **Pain relieved with forward flexion (walking uphill)
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| **Pain worse with extension (walking downhill)
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| *Decompressive laminectomy for severe persistent pain
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| *Adding spinal fusion to decompression improves outcome
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| *Even with surgery, symptoms may reoccur in a few years
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| ==Chronic Back Pain==
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| *Neural remodeling and neuro-plasticity may explain chronic pain in absence of ongoing tissue injury - alters perception of pain
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| *Intensive exercise helps
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| *Antidepressants, especially tricyclics (better than SSRI), also helpful
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| *No long term opioids
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| *Goals may need to be refocused
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| *Multiple surgical procedures are not helpful
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| ==Prevention==
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| *Corsets and education not helpful
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| *Weight loss, exercise, smoking cessation helpful
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| ==References==
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| <references/>
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| [[Category:Neurology]]
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| [[Category:Orthopedics]]
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