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From the Publishers of A Pain in the Back COPYRIGHT © 2013, ALL RIGHTS RESERVED Terms of Use The Consult Guys® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the Consult Guys® slide sets constitutes copyright infringement. Copyright © 2013 Copyright © 2013 Copyright © 2013 ACP Guideline Published in 2011 http://annals.org/article.aspx?articleid=746774 Copyright © 2013 Key Points Back pain is very common A selective approach to back pain imaging is recommended Copyright © 2013 Indications for immediate imaging Major risk factors for cancer as a cause Risk factors for spinal infection Evidence of cauda equina syndrome Copyright © 2013 Urinary retention Fecal incontinence Saddle anesthesia Mr. G Diabetic Boil 3 weeks ago Malaise Tenderness L3-L4 Copyright © 2013 Epidural abscess Identifiable portal of entry in 2/3 Spinal surgery Epidural catheter Skin – soft tissue infection Hematogenous (iv drug use) Classic: fever + spine tenderness + neurologic Most not classic MRI Copyright © 2013 Consult Guys Replies Mr. G’s presentation suggests epidural abscess An MRI should be done Copyright © 2013 Produced by and COPYRIGHT © 2013, ALL RIGHTS RESERVED