J Neurol Surg A Cent Eur Neurosurg 2015; 76 - A077
DOI: 10.1055/s-0035-1566396

Lower Back Pain—Caution When Making Treatment Program

Dragana Okiljević-Obradović 1, Dusanka Predojevic 1, G. Uzelac Kovacevic 1, J. Usljebrka 1, E. Zjalic 1
  • 1Specialist Hospital for Neurological and Posttraumatic Conditions “Dr Borivoje Gnjatić,” Stari Slankamen, Serbia

When discussing the lower back pain syndrome, one can say it is “a disease of civilization,” given that 80% of people experience it at least once during their lifetimes.

Over the 2-year period, 341 patients with lumbosacral spine pain were treated in our hospital. Apart from degenerative diseases, the most common is DH: 163 operated and 117 not operated.

Clinical features are often not accompanied by expected findings on X-ray, MRI, EMNG, and vice versa. Complications after surgery of DH are usually rare, one of them being spondylodiscitis, an inflammatory process localized in the intervertebral space and the body of vertebra. It can be primary or secondary.

The secondary is spondylodiscitis after operative treatment of DH, with only 2 to 3% described in reference books. Clinical features are often untypical, without the expected laboratory analyses, febrility, and other common side effects.

The paper describes two cases observed over a 2-year period, evaluated both on admission and after 2 years, through MMT, range of motion, VAS, and other diagnostic procedures.

I: treatment of large disc protrusion at the L4L5 level—conservative.

Described order of therapeutic procedures with strict adherence to dosage and controlled kinetic treatment, regular work, electrical, laser, magnetic therapy with gradual loading, and the introduction of hydrotherapy in the final phase.

II: secondary spondylodiscitis after operation DH L4L5.

When spondylodiscitis is suspected, one must emphasize the importance of specific laboratory analyses, CRP serum protein electrophoresis, sometimes being substantially higher, despite the routine laboratory, the treatment consisting of absolute rest and complex antibiotic therapy. The treatment protocol will be presented in detail.

Both representations demand caution during examinations, giving equal importance to detailed case history, diagnostic parameters, as well as subjective pain, and proper assessment of treatment and ways to implement it.

Keywords case history; assessment; additional diagnostics; individual treatment.