Is every chronic low back pain benign?: Case report

doi:10.1016/j.surneu.2006.01.028

Surgical Neurology

Volume 66, Issue 4, October 2006, Pages 357-360

https://doi.org/10.1016/j.surneu.2006.01.028 Get rights and content

Abstract

Background

There is a well-recognized association between chronic back pain and the existence of an AAA. In literature, there are few reported AAA cases that describe patients with extensive pressure erosion of the vertebral body.

Case Description

The authors present the case of a 38-year-old woman with chronic low back pain for the last 2 years in whom an AAA was formed during the follow-up period. The patient presented with an episode of low back pain following hard work 2 years ago. MR imaging of the lumbar spine was reported as disc degeneration at the L4-5 and L5-S1 levels. She was given medical treatment and was doing well with occasional back pain for a year. One year later, she suffered another disabling pain attack, and MR imaging revealed an additional focal disc protrusion at the L4-5 level. She was again medically treated. In August 2004, she presented with severe low back pain, and this time, MR imaging showed edema and erosion at the anterior part of L3 vertebra body. MR imaging studies (2- and 3-dimensional) depicted AAA as the cause. She was operated on, and the aneurysm was resected with graft repair of the site. She was pain-free in the postoperative period.

Conclusions

The evaluation of a patient with chronic back pain needs a thorough clinical and radiological workup. Limited evaluation of the bony and nervous structures of the spinal canal radiologically is insufficient. Pre- and paravertebral structures as well as vertebral body should carefully be evaluated to diagnose other causes of pain.

Introduction

Chronic back pain is one of the most frequent symptoms in neurosurgical practice. However, the anterior side of the spine does not attract much attention. AAAs are located ventrally in the spinal column and are frequently associated with chronic back pain. Erosion of an aneurysm into the vertebral body causes pain even in the absence of a rupture [12]. Clinical diagnosis is difficult if the aneurysm is located posteriorly and is not palpable [4]. Radiological diagnosis is important in a patient presenting with back pain as an only symptom, and a thorough evaluation of the spinal column including all the paraspinal spaces is mandatory for diagnosis. We report on a patient with chronic back pain secondary to an AAA that eroded the anterior portion of the third lumbar vertebra.

Section snippets

History

This 38-year-old woman presented with acute pain in the back, radiating to the right buttock in June 2002. Her pain was most intense when bending forward and was relieved on recumbent position. She had been working as a janitor for 5 years in the department of cardiovascular surgery. Her pain began after heavy work. She had no other diseases except sinusitis of the maxillary and frontal sinuses for which she received medical therapy including antibiotics every winter.

Her neurological

Discussion

There is a well-recognized association between chronic back pain and the existence of an AAA [3], [10]. Previously reported cases describe patients with extensive pressure erosion of the vertebral body [5], [7], [11]. However, this case is unique because the pain originally was associated with 2 pathological conditions together, degenerative disc disease and a prevertebral soft tissue mass, most probably lymphadenopathy. The erosion of the posterior wall of the abdominal aorta and an infectious

Conclusions

The evaluation of a patient with chronic back pain needs a thorough clinical and radiological workup. Degenerative disc disease lead spine surgeons to perform discography, spine mobility testing, and even instrumentation [9]. However, the underlying overlooked reason for chronic low back pain may be completely different and sometimes fatal if left untreated. The reasons of chronic low back pain should be eliminated carefully and systematically. Limited evaluation of the bony and nervous

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SpineIs every chronic low back pain benign?: Case report

Abstract

Background

Case Description

Conclusions

Introduction

Section snippets

History

Discussion

Conclusions

Comput Med Imaging Graph

Ann Vasc Surg

Ruptured abdominal aortic aneurysm simulating pyogenic vertebral spondylitis

AJR Am J Roentgenol

Severe erosion of lumbar vertebral body because of abdominal aortic false aneurysm

Spine

Contained rupture of the aneurysm of common iliac artery associated with pyogenic vertebral spondylitis

Spine

Spine
Is every chronic low back pain benign?: Case report