Mrs. Li is 78 years old and has been living alone since the death of her partner, and has always taken care of herself. One night when she was washing her feet, she sat down on the floor and felt pain in her lower back, and got up reluctantly and put pain relief cream on her back. The next morning, she still felt pain in her lower back, and when she bent over to brush her teeth, she suddenly felt a sharp pain in her lower back, and her lower limbs were as sore and numb as if she had been electrocuted, so she fell to the ground involuntarily. X-rays showed a compression fracture of the first lumbar vertebra, with a compression of about 2/3 of the vertebral body, and CT showed a compression fracture of the first lumbar vertebra, with an intra-vertebral canal occupancy of about 60%. The orthopedic surgeon immediately performed emergency surgery on her. After the surgery, although Mrs. Li regained her walking function, her bowel function was not normal due to the damage to the spinal cord.
Mrs. Li’s lesson was very hard, and if she had gone to the hospital in time, such a situation would not have happened. Below we introduce some common critical diseases with back pain as the main symptom, so that you can make an early judgment and go to the hospital in time without delaying your condition.
I. Severe low back pain that appears suddenly without obvious traumatic triggers
Generally speaking, low back pain often has an obvious history of trauma. However, there are some exceptions, and it is these sudden severe back pain without obvious traumatic triggers that need to be careful and go to the hospital as soon as possible so as not to delay the condition.
Manager Wang is usually in good health, and he often exercises in his spare time, so he has never experienced low back pain. One day after dinner, he suddenly felt a sharp stabbing pain in his left lumbar back, like a knife, so painful that he rolled all over the floor, his family immediately sent him to a nearby hospital for medical treatment, urinalysis showed: hematuria ++, X-ray film suggests: the left kidney area can be seen a translucent shadow, the doctor diagnosed the left kidney stone, and timely symptomatic treatment. Then he was successfully treated with extracorporeal ultrasonic lithotripsy during his hospitalization.
Sudden back pain without obvious history of trauma like Mr. Wang deserves careful treatment. This is often the main symptom at the onset of urinary stones, commonly kidney stones and ureteral stones. Most of these patients are accompanied by carnal hematuria and must be seen in hospital promptly.
Chronic back pain with urine changes
Some patients with inflammatory kidney diseases also have chronic back pain of varying degrees in their complaints, and some of them have been cured by timely treatment. There are also many patients who have delayed the disease due to lack of awareness of the disease.
Young Wang had just started working, and because of her weak constitution, she often caught colds. Soon after, she found that she had a lot of foam in her urine and often felt soreness in her lower back, but due to her busy schedule, she did not pay attention to it. A month later, she found that her nighttime urination had increased, from two or three times to five or six times, and her urine was obviously cloudy. She rushed to the hospital for treatment. After laboratory tests, the doctor diagnosed chronic glomerulonephritis with moderate damage to kidney function.
Patients with back pain who have accompanying changes in urine (including urine color, urine volume, and trait) must be alert. This is because there are many inflammatory kidney diseases such as acute and chronic glomerulonephritis and pyelonephritis, etc. that appear with low back pain as the first sign. Once the function of the glomerulus is destroyed, it is quite difficult to restore the function of the kidney. Therefore, early diagnosis and treatment of low back pain caused by inflammatory diseases of the kidney is necessary to prevent the condition from progressing to the point of kidney function damage.
Third, acute low back pain with high fever
There are many acute inflammatory diseases of the kidneys or lumbar spine that can also cause low back pain and are often accompanied by high fever. Patients suffering from these diseases need to go to the hospital immediately. Because acute inflammation develops rapidly, some can progress to sepsis within a few days, causing life-threatening conditions.
Two days ago, Xiao Li went to the hospital because of toothache and was diagnosed with gum abscess, the doctor cut open the abscess, put sterile gauze to fill it, and ordered oral antibiotics. Since the toothache was obviously better, Xiao Li left the doctor’s advice behind and did not take antibiotics. The first time I saw the company, I felt a soreness in my right side and weakness, my body was hot and cold, and my temperature was 39.8 C. I was so scared that I took a taxi to the hospital. The doctor gave him a blood test and the report showed that the white blood cells were 2300/mm3 and 93.7% of neutrophils, and the ultrasound showed that the right kidney was abscessed. After high-dose antibiotic treatment, Xiao Li was discharged from the hospital.
Anna is an eight-year-old girl who has just started the first grade of elementary school. A week ago got acute purulent tonsillitis, the doctor after anti-infection treatment, Anna’s temperature returned to normal, the swelling and pain at the cheekbone symptoms also disappeared, but she always said the back pain. The parents thought it was because she was weak after the disease and did not pay attention to it. A week later one morning, Anna suddenly launched a high fever, but also talking nonsense, followed by twitching of the limbs, parents rushed her to the nearby hospital for treatment. The doctor diagnosed septic spondylitis after laboratory tests.
Patients with perinephric abscess and septic spondylitis in the acute stage have early complaints of back pain, followed by chills, high fever, and even coma, and other severe symptoms of systemic toxicity. All of these patients should go to the hospital as soon as possible for examination to clarify the nature of the disease and early treatment so that the acute inflammation does not progress to the point of endangering the patient’s life. Here, we remind you: if you have inflammatory lesions in any part of your body you must be on the alert, because this may be the root cause of your back pain.
Chronic low back pain with progressive wasting of the body
Any unexplained cause of progressive wasting of the body must be treated seriously. Patients with low back pain who are accompanied by progressive wasting of the whole body must be alert. This is a sign of wasting disease (such as renal tuberculosis, lumbar spine tuberculosis), or cancer (such as malignant tumor of kidney, malignant tumor of lumbar spine, etc.), and the prognosis is not good.
Xiao Zhou is an accountant of a unit, in the past 3 months, she always felt soreness in the back, slightly reduced after rest, often night sweats, often felt weakness in the limbs, and her weight dropped from more than a hundred pounds to more than ninety pounds. Due to her busy work schedule, she did not go to the hospital and only took oral ginseng pills. One morning at work, Zhou sneezed and felt a sharp pain in her lower back, so painful that she could not even straighten her back. Her colleagues rushed her to the nearby hospital for emergency treatment. The doctor did an X-ray examination for her, and the report suggested: pathological fracture of the 3rd lumbar vertebra, and the first consideration was lumbar spine tuberculosis.
Old Wang is fifty-six years old and is usually physically fit. In the past six months, Wang has been feeling back pain. At first, he did not care about it, thinking that it was due to old age and kidney deficiency, and he was busy in the unit, so he did not go to the hospital and took Paulownia ginseng by himself, and felt that his back pain was slightly reduced. In recent days, he felt that the back pain was significantly worse than before, and he was weak. People around him said he looked too bad, and his weight dropped from a hundred and fifty pounds six months ago to a hundred and some pounds. He immediately went to the hospital for examination. Ultrasound showed an occupying lesion in the right kidney with unclear borders, accompanied by ascites, and CT showed a substantial occupying lesion of about 5.2×4.1×4.2 cm in the right renal pelvis with unclear borders. It was considered a malignant tumor of the right kidney. The surgeon immediately performed a right nephrectomy for the cancerous tumor. However, because the tumor had spread, the lesion could not be completely removed. Three months later, Lao Wang passed away.
V. Acute low back pain with a history of major trauma
With modern industrial development, it is not uncommon to see lumbar injuries brought about by high-speed high-energy injuries, such as kidney contusions and spinal fractures. These injuries often have serious consequences, and if you do not pay attention to them and do not send them to the hospital as soon as possible, they can bring about lifelong disability and even life-threatening.
Xiao Wang is a racing fan. One day, he went to play go-karting with some friends, and when he got off the car, he was hit by a speeding car on the right side of the waist, that is, he felt a sharp pain in the waist, and his companions helped him to rest to the side. Shortly after, he felt the pain in his lower back increased, and his body was cold sweat, panic, his companions immediately sent him to a nearby hospital for treatment. The doctor immediately performed a laparotomy and drew out 50ml of bloody fluid, the ultrasound indicated that the right kidney was contused and a large amount of blood had accumulated in the abdominal cavity, and the blood count indicated that the hemoglobin was only 6g/ml. About 1500ml of blood was removed during the operation and the right kidney wound was repaired surgically. When the surgeon came out of the operating room, he said to Xiao Wang’s companion, “Fortunately, I was sent to the hospital one step earlier, otherwise Xiao Wang’s life would not have been saved.” Two weeks later, Xiao Wang was discharged from the hospital after healing.
Xiao Li is a construction worker. One day while working on a two-meter-high scaffold, he accidentally stepped on a foot and fell to the concrete floor. At that time, he only felt some soreness in his back, he could still stand and walk, so he took a short rest and went to lift the cement with his colleagues. Lift the cement only a few steps, Xiao Li felt a sharp pain in the waist, legs a soft, fell to the ground, the lower extremities immediately lost consciousness, can not move. Colleagues carried him into the nearby hospital with their arms and legs. The doctor immediately did a thorough examination for him, and the X-ray suggested that the 12th thoracic vertebra was fractured and compressed by about 1/2. CT suggested that the 12th thoracic vertebra was burst fractured and the spinal canal was occupied by about 1/2 of the severely compressed spinal cord. The orthopedic surgeon immediately performed a decompression of the vertebral plate with internal fixation. Three months after the surgery, Xiaoli went through active rehabilitation exercises, and the sensation and muscle strength of both lower limbs returned to normal and went back to work.
The experience of Xiao Wang and Xiao Li tells us that we must be cautious of the back pain caused by certain serious traumatic conditions, because the injuries brought about by these high-energy injuries are relatively serious, and only if they are sent to the hospital as quickly as possible in an emergency can we gain valuable time and have the possibility of being cured, otherwise the consequences are unthinkable.
Sixth, acute and chronic low back pain with single (or double) lower extremity neurological symptoms
Here, we refer to lower limb neurological symptoms, including lower limb sensory and motor dysfunction, including lower limb pain, numbness, and weakness, mostly unilateral, but there are also bilateral lower limbs with neurological symptoms. The diseases that cause these symptoms include what we usually call sciatica. These symptoms indicate that the nerve roots or spinal cord in the lumbar spinal canal are being compressed, and patients with low back pain must be vigilant and go to the hospital as soon as possible to get a clear diagnosis so that they can receive timely and correct treatment and develop a long-term health care plan.
When Liu was young, he loved sports and played on the school volleyball team in college. In a game sprained the waist, when lying on a hard bed rest a few days after the lumbago improved. After joining the workforce, he felt soreness in his lower back and soreness in his right calf whenever he was tired. At first he did not care, he put plasters on his back and rested in bed for a few days, and resumed work after the symptoms were relieved. But as he got older, the lumbago attacks became more frequent, and the skin of the outer calf and the back of the foot became numb, and he felt that his right foot was not strong enough, and people around him said that Liu was walking with a limp. He went to the hospital for a checkup, and the CT indicated that the lumbar 4-5 disc was protruding to the right rear, compressing the nerve root and dural sac. A week later, the doctor did a disc nucleus pulposus removal for him. After the operation, the soreness and swelling of Liu’s waist and right calf basically disappeared, but the numbness of the right calf and dorsum of the foot persisted, and he walked with a slight limp.
Xiao Zhou is a computer operator who usually feels soreness in his lower back after working for a long time and often feels numbness in the bottom of his feet. He thought he was sitting for a long time and blood vessels, put a plaster on the waist or get up and move around, but the symptoms did not ease. So he went to the neurology department of the hospital. Magnetic resonance examination suggested that bilateral sacral 1 nerve root nerve sheath tumors were possible. During his hospitalization, the neurosurgeon performed surgery on him, and the pathology report was consistent with the magnetic resonance diagnosis. Two weeks after the surgery, Xiao Zhou was discharged from the hospital with healing.
The cases of Lao Liu and Xiao Zhou remind us that when you have low back pain accompanied by single (or double) lower limb nerve symptoms (such as soreness, numbness, weakness, etc.), you should go to the hospital as soon as possible. This is because it is often the first sign of an occupying lesion in the lumbar spinal canal. Early symptoms of nerve root or spinal cord compression are mostly single (or double) lower extremity soreness, and when numbness and weakness in the lower extremities occur, it indicates that the nerves are starting to degenerate and the prognosis is poor. The following diseases can cause lower extremity nerve symptoms: lumbar disc herniation, lumbar spinal stenosis, lumbar spinal canal tumor, lumbar spinal slippage, etc.
Low back pain with lumbar spine deformity
The spine is the “beam” of the human body. The normal spine looks straight from the front and has four physiological curves from the side: anterior cervical curve, posterior thoracic curve, anterior lumbar curve, and posterior sacral curve. From a biomechanical point of view, the normal physiological curve of the human spine is quite important to maintain the normal movement of the human body. There are many spinal disorders that can disrupt the normal physiological curve of the human spine, causing deformities in the lumbar spine and resulting in motor kinetic disorders. Therefore, patients with lumbar pain who have lumbar deformities (such as scoliosis, physiological anterior bending or deepening) should go to the hospital as soon as possible.
Soon after his enlistment in the army, Sergeant Xiao Jin often felt stiffness and soreness in his lower back when he got up in the morning, but felt less soreness in his lower back after training. He thought it was because he was not used to lying on a hard bed, so he did not take it seriously. This symptom was maintained for about half a year, until his comrades around him said that his shoulders were high and low, and he went to the army hospital for consultation. After an X-ray examination, the doctor found that his sacroiliac joint bone density was abnormally high, his lumbar spine was severely scoliosis, and his physiological anterior curvature had disappeared. Blood tests showed that he was positive for HLA-B27 (human lymphocyte histocompatibility antigen). The diagnosis was ankylosing spondylitis. After inpatient symptomatic treatment, Xiao Jin’s back pain symptoms improved significantly. One month later, Xiao Jin went through the discharge procedure.
Xiao Ming is a lively and cute little boy who just started the fourth grade of elementary school this year. His attentive parents noticed that his left shoulder was significantly higher than his right shoulder, and Xiaoming usually said that he felt soreness in his left side of his back after doing homework for a long time. So, his parents took Ming to a large hospital orthopedic department for treatment. After an X-ray examination, the doctor diagnosed him with congenital scoliosis, and promptly treated him with manipulation and traction. One month later, Xiao Ming no longer said he had back pain and his spine was back to normal.
The cases of Xiao Jin and Xiao Ming gave us a preliminary understanding of low back pain caused by lumbar spinal deformity. In fact, many spinal diseases can destroy the normal lumbar curve of the human body, some are congenital, such as: congenital scoliosis, hemivertebral deformity, butterfly spine deformity, congenital lumbar spine fracture, lumbosacral displaced vertebrae, etc.; some are caused by acquired degeneration, such as: lumbar disc herniation, lumbar vertebral pseudoprosthesis, lumbar spinal stenosis, etc.; some are caused by inflammation, such as: lumbar tuberculosis, posterior spondylolisthesis, ankylosing spondylitis, vertebral osteoarthritis, etc. All of these diseases can cause lumbar spine deformity, thus causing back pain to patients. Therefore, patients must go to the hospital early for a clear diagnosis and early treatment to prevent sequelae or more serious consequences.
Eight, chronic low back pain with intermittent claudication
The so-called intermittent claudication refers to the patient walking a short distance (generally a few hundred meters), the appearance of low back pain, or both lower extremities soreness and numbness, weakness and even limp, but after resting in a squatting position for a few minutes, the soreness and pain symptoms can be relieved or disappear, and the patient can continue to walk, and then walk a short distance after the above symptoms reappear, and again to squat and rest. This situation occurs repeatedly, and because the claudication occurs intermittently during this process, it is called intermittent claudication. This is a typical symptom of spinal stenosis.
Old pay this year, has always had chronic back pain, recently walked less than one stop on the calf swelling pain, sit down and rest for a few minutes and can continue to walk. Old payment presumed to be the reason that people old legs first old, also did not go to the hospital for examination. Unit organization retired cadres to go to Mount Huashan tourism, who knows the mountain road did not walk a few steps, can no longer walk, only to return to the happy. After returning home, Lao Fu immediately went to the hospital, by the doctor an examination to know that they have lumbar spinal stenosis. After the doctor’s surgery, the symptoms of intermittent claudication disappeared.
This type of chronic low back pain with intermittent claudication often has no obvious symptoms when cycling, so they often wait until they can barely walk before going to the hospital. Here we remind you that if you have chronic low back pain accompanied by intermittent claudication symptoms, you should not take it lightly and should go to the hospital as soon as possible for treatment.
Chronic low back pain with dysfunction of stool and urine
Normal human bowel and urine function is controlled by two nerve centers: (1) sacral medulla 2, 3, 4 and cauda equina; (2) cerebral cortex. If one of the two centers is damaged, the whole function of stool and urine will be impaired. Among the disorders that cause chronic low back pain, there are many that cause compression of the sacral medulla 2, 3, 4 and cauda equina nerves, resulting in dysfunction of the bowel and urine, such as occult spina bifida, lumbar spinal stenosis, cauda equina tumors, etc. Then, if you have a history of chronic low back pain and at the same time, you must go to the hospital as soon as possible to make a clear diagnosis and get timely and correct treatment.
The doctor diagnosed him with occult spina bifida and suggested he go to a large hospital for a CT examination. A week later, the neurosurgeon performed surgery on him, which was quite successful. After the surgery, Xiao Li’s unspeakable condition was completely solved and the symptoms of back pain disappeared.
Mr. Sun is 28 years old and has stepped into the workplace talent for 4 years. But the history of low back pain has more than 3 years, usually has been vague pain, she thought it was due to long-term sitting work, and did not care. However, in the last half month, she felt that she could not control her bowel movements and had to go to the toilet immediately if she had the slightest urge to do so, otherwise she would shit on her pants. After CT and MRI examination, the doctor diagnosed her with cauda equina tumor and immediately performed surgery to remove it. After the surgery, her bowel and urine functions were back to normal.
The cases of Xiao Li and Sun are not uncommon in clinical practice. When a patient with chronic low back pain is accompanied by dysfunction of stool and urine, the possibility of sacral medulla or cauda equina nerve compression or lesion should be considered and should be seen in a hospital as soon as possible. Since the loss of function of the central nerve is irreversible, such diseases should not be delayed, otherwise once the nerve is degenerated, the possibility of restoring the function of the second stool is slim.
Ten, gynecological disorders caused by low back pain
Many women, especially those suffering from gynecological disorders such as uterine prolapse, retroversion of the uterus, uterine adhesion, endometritis, tubal inflammation, cervicitis, pelvic reproductive organ tumors, often have symptoms of low back pain, accompanied by symptoms of gynecological diseases, such as: lower abdominal cramps, dysmenorrhea, irregular menstruation, increased leucorrhea, etc. The onset is often related to the menstrual cycle.
Xiao Zhang is 27 years old and has been suffering from low back pain since she was a teenager. Each episode of low back pain also occurs five or six days before the menstrual period, and the symptoms disappear after the period. She has also heard of similar conditions among her girlfriends, so she has not gone to the hospital. When she was about to get married, she went for a premarital checkup with her boyfriend, and the doctor found out through the examination that Zhang was suffering from endometriosis.
The main reason why gynecological disorders can cause low back pain is because the nerves of the uterus and its adnexa come from the pelvic visceral nerves under the abdomen and the sympathetic nerves of the ovaries from and parasympathetic nerves, which all start from the 2nd-4th sacral nerves, and when lesions of the above organs involve these nerves, they can reflexively cause symptoms of low back pain. Therefore, women with chronic low back pain who also have gynecological disease symptoms should go to the hospital for gynecological examination as soon as possible to make a clear diagnosis so as to avoid misdiagnosis and loss of treatment.