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    Geriatric Low Back Pain: Presentation: Martin Young, Michelle A Wessely

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    Radiographs were taken (Figs. 2, 3a and b). These revealed extensive degenerative changes at all lumbar levels, with bridging osteophytes anteriorly. There was evidence of the previous laminectomy and fusion at L3/4. The sacroiliac joints appeared normal. Clinical impression The clinical picture was consistent with acute exacer- bation of chronic lumbar degenerative changes, likely secondary to the recent fall. The neurological deficit was consistent with the previous iatrogenic injury. Given the patient's frailty and multiple co-morbidities, surgical intervention was not considered appropriate.

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    Geriatric Low Back Pain: Presentation: Martin Young, Michelle A Wessely

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    Radiographs were taken (Figs. 2, 3a and b). These revealed extensive degenerative changes at all lumbar levels, with bridging osteophytes anteriorly. There was evidence of the previous laminectomy and fusion at L3/4. The sacroiliac joints appeared normal. Clinical impression The clinical picture was consistent with acute exacer- bation of chronic lumbar degenerative changes, likely secondary to the recent fall. The neurological deficit was consistent with the previous iatrogenic injury. Given the patient's frailty and multiple co-morbidities, surgical intervention was not considered appropriate.

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    Radiographs were taken (Figs. 2, 3a and b). These revealed extensive degenerative changes at all lumbar levels, with bridging osteophytes anteriorly. There was evidence of the previous laminectomy and fusion at L3/4. The sacroiliac joints appeared normal. Clinical impression The clinical picture was consistent with acute exacer- bation of chronic lumbar degenerative changes, likely secondary to the recent fall. The neurological deficit was consistent with the previous iatrogenic injury. Given the patient's frailty and multiple co-morbidities, surgical intervention was not considered appropriate.

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    17 views3 pages

    Geriatric Low Back Pain: Presentation: Martin Young, Michelle A Wessely

    Uploaded by

    tito
    Radiographs were taken (Figs. 2, 3a and b). These revealed extensive degenerative changes at all lumbar levels, with bridging osteophytes anteriorly. There was evidence of the previous laminectomy and fusion at L3/4. The sacroiliac joints appeared normal. Clinical impression The clinical picture was consistent with acute exacer- bation of chronic lumbar degenerative changes, likely secondary to the recent fall. The neurological deficit was consistent with the previous iatrogenic injury. Given the patient's frailty and multiple co-morbidities, surgical intervention was not considered appropriate.

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    Clinical Chiropractic (2006) 9, 109—111

    intl.elsevierhealth.com/journals/clch

    CASE CHALLENGE

    Geriatric low back pain: Presentation


    Martin Young a, Michelle A Wessely b,*

    a
    Yeovil Chiropractic Clinic, 142, Sherborne Road, Yeovil, Somerset BA21 4HQ, UK
    b
    Department of Radiology, Institut Franco-Europeen de Chiropratique (IFEC),
    24 Boulevard Paul Vaillant Couturier, 94200 Ivry Sur Seine, France

    Received 25 May 2006; accepted 31 May 2006

    History his orthopaedic surgeon fitted a right hip prosthesis.


    In 2003, he was operated upon again, this time
    A chiropractic patient contacted her local clinic replacing the right knee (Fig. 1).
    requesting a house visit for her 79-year-old husband, Unfortunately, he experienced complications
    a retired engineer who had been confined to his bed with this surgery, developing a methicillin resistant
    for the previous 5 weeks with acute, severe low back Staphylococcus aureus (MRSA) infection at the sur-
    pain. On attending, the patient was in a makeshift, gical site. Despite extensive treatment, the infec-
    ground floor bed, being unable to climb the stairs to tion persisted and he re-entered hospital in October
    his usual bedroom. He was able to rise to his feet, 2005 to surgically remove a nidus of infection in his
    but was only able to stand if supported and found tibia. He subsequently developed a deep vein
    any movement unbearably painful. thrombosis, which resulted in a pulmonary embo-
    Mr D had an extensive orthopaedic surgical his- lism. During his extended stay in hospital, he began
    tory commencing in 1963 when he was involved in a complaining of low back pain; this was aggravated
    road traffic accident in which he was thrown through when he suffered a fall approximately seven weeks
    the windscreen of a car, suffering a broken nose and prior to his house call, whilst still an in-patient. He
    extensive soft tissue trauma to the knees. Although had been suffering back pain ever since, although
    he reported no history of back pain prior to 1993, in his knee appeared to be healing satisfactorily. His
    that year he attended an orthopaedic surgeon general practitioner had prescribed analgesia and
    reporting a 6-month history of back pain, diagnosed bed-rest.
    as degenerative spinal stenosis. He underwent a
    laminectomy and surgical fusion with a Harrington
    Plate; unfortunately, the right sciatic nerve was Clinical findings
    severed during this procedure.
    In 1998, the same surgeon fitted a left knee On examination, neurological deficit was noted, con-
    prosthesis; in 2000, he had a partial colonectomy sistent with the iatrogenic neuropathy noted above.
    to remove a cancerous growth; the following year, Lumbar range of motion was universally painful and
    restricted. The psoas muscles were both weak, par-
    ticularly on the left (3/5), and gravitational resis-
    * Corresponding author. Tel.: +33 1 4515 8918;
    fax: +33 1 4515 8911.
    tance recreated the mid-lumbar element of the low
    E-mail addresses: clinchiro@elsevier.com (M. Young), back pain. Extensive guarding was noted in the erec-
    mwessely@ifec.net (M.A. Wessely). tor spinae, quadratus lumborum, sacrospinalis and

    1479-2354/$32.00 # 2006 The College of Chiropractors. Published by Elsevier Ltd. All rights reserved.
    doi:10.1016/j.clch.2006.05.001
    110 M. Young, M.A. Wessely

    Figure 2 Postero-anterior weight-bearing lumbo-pelvic


    radiograph.
    Figure 1 Lateral radiograph of the right knee.

    Figure 3 Lateral weight-bearing lumbo-sacral radiograph (a) with spot view (b).
    Geriatric low back pain: Presentation 111

    glutei bilaterally. Straight leg raise could not be  What is your immediate management plan for this
    performed on the right owing to the recent surgery, patient?
    but was normal on the left. The patient was afebrile;
    pulse and blood pressure were unremarkable. The patient was treated palliatively and arrange-
    ments were made for early radiological examination
     What is your differential diagnosis at this stage? (Figs. 2, 3a and b).
     Are there any further tests you would wish to
    perform?

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