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Back Pain 107

Back Pain Client Education
Sheet
VetBooks.ir Diseases and Disorders

BASIC INFORMATION
eliciting and, if possible, localizing signs of
arthritis), culture (septic polyarthritis or
back pain. Diagnostic imaging and specific • Arthrocentesis (p. 1059): cytology (poly-
Definition techniques then help to elucidate the source of meningitis)
Pain localized to the thoracolumbar spinal the pain. • Serum protein electrophoresis and bone
column marrow if suspect multiple myeloma
Differential Diagnosis (p. 663)
Synonyms • Spinal, orthopedic • Biopsy of vertebral bone (neoplasia,
Spinal hyperesthesia or hyperpathia • Spinal, neurologic osteomyelitis)
• Vascular
Epidemiology • Other (abdominal, limb, cutaneous, anxiety)
SPECIES, AGE, SEX For a detailed differential diagnosis, see p. 1202. TREATMENT
Depends on the underlying cause Treatment Overview
• Dogs: middle-aged adults (type I inter- Initial Database • Elimination of infectious or noninfectious
vertebral disc disease [IVDD], acute non- • Neurologic and orthopedic exams (pp. 1136 paraspinal inflammatory causes
compressive nucleus pulposus extrusion and 1143) • Elimination of any compressive lesion on
[ANNPE]), older adults (type II IVDD, • CBC, serum biochemistry profile, urinalysis: spinal cord or nerve roots
neoplasia) often unremarkable unless systemic disease • Stabilization of vertebral column
• Cats: older adults (neoplasia), males > females or infection present
(aortic thromboembolism) • Radiographs: bone lysis or proliferation Acute General Treatment
(neoplasia, osteomyelitis), vertebral fracture Address the underlying cause.
GENETICS, BREED PREDISPOSITION or luxation (trauma), intervertebral disc
Dogs: chondrodystrophic breeds (type I IVDD) mineralization, disc space narrowing, Chronic Treatment
wedging or displacement (IVDD, ANNPE), • Degenerative joint disease may require
RISK FACTORS vertebral endplate lysis or proliferation persistent or recurrent nonsteroidal antiin-
Cats: thromboembolism associated with (discospondylitis), articular facet sclerosis flammatory drug (NSAID) administration.
cardiomyopathy and malformation, spondylosis. Radiographs See Hip Dysplasia section (p. 469) for
may be unremarkable. medication options.
Clinical Presentation • Chronic IVDD or immune-mediated disease
HISTORY, CHIEF COMPLAINT Advanced or Confirmatory Testing may require intermittent or persistent cor-
Vocalization, reluctance to movement or Selection is based on history, clinical signs, and ticosteroid treatment.
activity, pain elicited if patient touched or results of initial database: • Antibiotic therapy for discospondylitis (p.
moved • Cerebrospinal fluid tap (pp. 1080 and 1323): 266) or vertebral osteomyelitis continued
cytologic evaluation, culture, serologic testing for 6 weeks beyond resolution of clinical
PHYSICAL EXAM FINDINGS for immunoglobulin A (IgA) or infectious signs
• Hunched posture (kyphosis), pain elicited on agents
epaxial palpation; ataxia, paresis, or paralysis; • Computed tomography (CT) allows three- Drug Interactions
heat or swelling in epaxial region; splinting dimensional assessment of the vertebral Glucocorticoids and NSAIDs must not be
and pain on abdominal palpation column; particularly useful for spinal administered concurrently because of the risk
• Fever, if back pain is associated with infection trauma or neoplasia; CT myelography is of severe gastrointestinal ulceration.
(e.g., discospondylitis) very sensitive for evaluating spinal cord
• Heart murmur, diminished femoral pulses, compression Possible Complications
cyanosis of toenails if back pain is associated • Magnetic resonance imaging (MRI) (p. 1132) • Worsening or recurrence of signs
with aortic thromboembolism has greater sensitivity than CT for spinal • Progression of spinal cord lesions
cord lesions without the need for myelog- • Myelomalacia
Etiology and Pathophysiology raphy and offers better evaluation of spinal • Valvular endocarditis, for infectious
• Neurogenic: compression, inflammation, or cord parenchyma. conditions
traumatic disruption of spinal cord, spinal • Myelogram: identify and discern among
roots, spinal nerves, dorsal root ganglia, or extradural compression (IVDD), intradural/ Recommended Monitoring
meninges extramedullary lesion (meningioma), and • Repeat physical and neurologic examination
• Vertebral column: trauma, inflammation, or intramedullary lesion (other neoplasia or within 12-24 hours of treatment.
lysis of vertebral bone, intervertebral discs, cord swelling, such as due to ischemic • Follow-up examination and radiographs as
or articular facets myelopathy). Often augmented by CT or needed
• Epaxial muscle: inflammation, abscessation, replaced by MRI when available
ischemia, or trauma • Urine culture (discospondylitis) PROGNOSIS & OUTCOME
• Blood culture and sensitivity (discospondy-
DIAGNOSIS litis, osteomyelitis, bacterial meningitis) Depends on underlying cause
(p. 1333)
Diagnostic Overview • Needle aspirate of intervertebral disc PEARLS & CONSIDERATIONS
Back pain often presents nonspecific physical (discospondylitis)
signs (or absence of any observable deficits). • Serologic titers: Brucella canis (discospon- Comments
Careful palpation and thorough neurologic dylitis), rickettsial diseases (polyarthritis, • Localization of pain requires thorough
and orthopedic examinations are used for meningitis) physical and neurologic examination.

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