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SpinalandspinalcordSpinalandspinalcord外傷科主治醫師外傷科主治醫師HsinglinHsinglinLowbackpainandradiculopathyLowbackpainandradiculopathyImagingstudiesandfurthertestingnotImagingstudiesandfurthertestingnothelpfulthefirst4weekshelpfulthefirst4weeksReliefofdiscomfortwithmedsandspinalReliefofdiscomfortwithmedsandspinalmanipulationmanipulationBedrestbeyond4daysmaybemoreBedrestbeyond4daysmaybemoreharmfulharmful89-90%lowbackpainimprovewithin189-90%lowbackpainimprovewithin1monthmonth80%sciaticaeventuallyrecover80%sciaticaeventuallyrecover1%havenerve-rootsymptoms1%havenerve-rootsymptoms1-3%havelumberdischerniation1-3%havelumberdischerniation85%nospecificdiagnosismade85%nospecificdiagnosismadedefinitions/classificationsdefinitions/classificationsRadiculopathy:dysfunctionofnerveroot(Radiculopathy:dysfunctionofnerveroot(pain,sensorydisturbances,weakness)pain,sensorydisturbances,weakness)Mechanicallowbackpain:strainofparaspiMechanicallowbackpain:strainofparaspinalmuscles,ligament,irritationoffacetjoinnalmuscles,ligament,irritationoffacetjointstsInitialassessmentofpatientInitialassessmentofpatientHistory:History:–age,weightloss,cancerorinfection,usedofdrug,duriage,weightloss,cancerorinfection,usedofdrug,duringofS/S,trauma,caudaequinasyndrome,workstatusngofS/S,trauma,caudaequinasyndrome,workstatusPE:PE:–fever,vertebraltenderness,limitedrangeofspinalcordfever,vertebraltenderness,limitedrangeofspinalcordDorsiflexationofankleandbigtoe–L5,4Dorsiflexationofankleandbigtoe–L5,4Achillesreflex–S1Achillesreflex–S1LighttouchLighttouchSLRtextSLRtextFurtherevaluationofpatientsFurtherevaluationofpatientsEMG:neuropathy,myopathy,myelopathy,EMG:neuropathy,myopathy,myelopathy,unreliable<3-4weeksunreliable<3-4weeksSEPs(somatosensoryevokedpotential):spiSEPs(somatosensoryevokedpotential):spinalstenosis,orspinalmyelopathynalstenosis,orspinalmyelopathyNCVs(nerveconductionvelocity):entrapmNCVs(nerveconductionvelocity):entrapmentneuropathiesthatmimicradiculopathyentneuropathiesthatmimicradiculopathyLSX-rayrecommendationLSX-rayrecommendationage>70yrs,or<20yrsage>70yrs,or<20yrssystemicallyillpatientssystemicallyillpatientstemp.38temp.38°C°CHistoryofmaligancyHistoryofmaligancyRecentinfectionRecentinfectionCaudaequinasyndromeCaudaequinasyndromeHeavyalcoholordrugabusersHeavyalcoholordrugabusersDMDMImmunosupressedpatients(steroid)Immunosupressedpatients(steroid)RecenttraumaRecenttraumaRecenturinarytractorspinalsurgeryRecenturinarytractorspinalsurgeryUnrelentingpainatrestUnrelentingpainatrestPersistentpainmorethan4weeksPersistentpainmorethan4weeksUnexplainedweightlossUnexplainedweightlossTreatmentTreatmentConservativetreatment:Conservativetreatment:–1.activitymodification:1.activitymodification:»Bedrest:nomorethan4daysBedrest:nomorethan4days»Activitymodification:heavylifting,totalbodyActivitymodification:heavylifting,totalbodyvibration,asymmetricpostures,sustainedforlongvibration,asymmetricpostures,sustainedforlongperiodsperiods»Exercise:walking,bicycling,orswimmingExercise:walking,bicycling,orswimming2.analgesics:2.analgesics:–PanadolandNSAIDsPanadolandNSAIDs–OpioidsOpioids3.musclerelaxants:3.musclerelaxants:–noeffectnoeffect4.education:4.education:–conditionwillsubsideconditionwillsubside5.spinalmanipulationtherapy:5.spinalmanipula...