000002937 001__ 2937
000002937 005__ 20190205112055.0
000002937 022__ $$a1066-9817
000002937 0247_ $$2DOI$$a10.1080/10669817.2017.1282189
000002937 037__ $$aARTICLE
000002937 041__ $$aeng
000002937 245__ $$aThe screening process of a patient with low back pain and suspected thoracic myelopathy :$$ba case report
000002937 260__ $$c2018-01
000002937 269__ $$a2018-01
000002937 300__ $$a7 p.
000002937 506__ $$avisible
000002937 520__ $$9eng$$aBackground: 
Thoracic disc herniations are rare and difficult to diagnose. Myelopathy is a potential consequence that can lead to irreversible neurological impairment if not treated appropriately. It is incumbent on all clinicians who see patients with low back pain (LBP) to be aware of such pathologies. This case describes a screening process in the detection of a rare serious spinal pathology and discusses the use of red flags and central nervous system signs and symptoms in the decision leading to immediate referral.
Case Description:
The subject in this case was a 69-year-old male referred to physical therapy for the treatment of LBP after having seen two medical doctors. He presented with severe spinal pain with gait disturbance, postural balance deficits and bilateral loss of plantar flexor strength. Decreased sensation in the buttocks and a subtle episode of urinary incontinence were also present.
Outcomes:
Based on the results of the history and physical examination, the patient was referred back to his medical practitioner, who ordered magnetic resonance imaging. A thoracic disc herniation associated with spondyloarthritis at T10–11 causing myelopathy was detected, and the patient underwent immediate decompressive surgery. One month following initial evaluation, the patient had completely recovered without any neurological compromise.
Discussion: 
This case highlights the importance of the screening of serious pathologies and the assessment of central nervous impairments in certain cases of LBP. The integration of a cluster of subjective and physical examination findings led to the prompt referral of this patient for urgent medical attention.
Level of Evidence: 4.
000002937 540__ $$acorrect
000002937 592__ $$aHESAV
000002937 592__ $$bUnité de recherche en santé, HESAV
000002937 592__ $$cSanté
000002937 592__ $$dPhysiothérapie
000002937 65017 $$aSanté
000002937 655__ $$ascientifique
000002937 6531_ $$9eng$$acase report
000002937 6531_ $$9eng$$aclinical reasoning
000002937 6531_ $$9eng$$adiagnostic tests
000002937 6531_ $$9eng$$ared flags
000002937 6531_ $$9eng$$aspine
000002937 700__ $$aChriste, Guillaume$$uHESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland
000002937 700__ $$aHall, Toby$$uSchool of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
000002937 773__ $$g2018, vol. 26, no. 1, pp. 11-17$$tJournal of Manual & Manipulative Therapy
000002937 8564_ $$uhttps://hesso.tind.io/record/2937/files/Christe_2018_the_screening_process_of_a_patient.pdf$$s1005670
000002937 906__ $$aNONE
000002937 909CO $$pGLOBAL_SET$$ooai:hesso.tind.io:2937
000002937 950__ $$aSan2
000002937 981__ $$ascientifique
000002937 980__ $$ascientifique