Backache is one of the most common complaints seen in general practice and orthopaedic clinics. Most causes are either traumatic or degenerative, but other causes are numerous and may occur as a result of pathology in almost any system of the body.

Causes

Congenital

  • Kyphoscoliosis

  • Spina bifida

  • Spondylolisthesis

Acquired

Traumatic

  • Vertebral fractures

  • Ligamentous injury

  • Joint strain

  • Muscle tears

Infective

  • Osteomyelitis – acute and chronic

  • TB • (common in parts of the world where TB is endemic)

  • Discitis

Inflammatory

  • Ankylosing spondylitis ( Fig. 6 )

    Figure 6, Bamboo spine .

  • Rheumatology disorders

Neoplastic

  • Metastases – multiple myeloma

  • Primary sarcomas

Degenerative

  • Osteoarthritis

  • Intervertebral disc lesions

Metabolic

  • Osteoporosis (associated vertebral fractures)

  • Osteomalacia

Endocrine

  • Cushing’s disease (osteoporosis)

Idiopathic

  • Paget’s disease

  • Scheuermann’s disease

Psychogenic

  • Psychosomatic backache

Visceral

  • Penetrating peptic ulcer

  • Carcinoma of the pancreas

  • Carcinoma of the rectum

Vascular

  • Aortic aneurysm

  • Acute aortic dissection

Renal

  • Renal calculus

  • Carcinoma of the kidney

  • Inflammatory disease

Gynaecological

  • Pelvic inflammatory disease

  • Endometriosis

  • Uterine tumours

History

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