(2) Lumbar Spine Pathologies Flashcards
(34 cards)
What is the diagnostic triage of lower back pain?
- Specific spinal pathology
- Radicular syndrome(s)
- Non-Specific LBP
What are red flags for lower back pain?
- Altered loss bladder/bowel control
- malignancy
- vertebral #
- spinal infection (unrelenting pain)
- 5 D’s (dizziness, double vision, dysarthria, dysphagia, drop attacks)
What are examples of non-specific LBP?
- Disc strain
- Facet joint
- Spondylosis
- Spondylolysis
- Spondylothesis
What is intervertebral disc pain?
- inflammation and tissue ischaemia
- collagen
changes/degrades - +/- annular tears
- loss water content
- > male
- 90% L4/5
What are the four stages of intervertebral disc injury?
- Bulging disc
- Protrusion
- Extrusion
- Sequestration
What can be seen clinically in a patient with intervertebral disc injury?
- hx bending & twisting
- agg: lift, bend, cough, prolonged sitting
- ease: lying, standing
- o/e: worst pain on flexion
What is lumbar radiculopathy?
- aka sciatica
- pain down entire affected leg
What causes lumbar radiculopathy?
- bulging disc
- nerve root impingement
- disc herniation
- degenerative changes
- tumor
What are symptoms of lumbar radiculopathy?
- +ve SLR
3 out of 4: - dermatomal pain distribution
- sensory, motor or reflex changes
What is seen clinically in a patient with lumbar radiculopathy?
- hx bending/twisting
- agg: lift, bend, sitting
- ease: lying, standing
- o/e: antalgic, decreased ROM, +/- dermatomes, myotomes & reflexes, +ve SLR
How do you differentiate with the patient whether it is disc or nerve pain?
- ask which is worse, leg or back pain
- rate each out of 100
What is Facet Joint Syndrome?
It is an irritated facet joint
What is seen clinically in a patient with facet joint syndrome?
- unilateral predominance
- pseudo-radicular pain distribution
- pain on extension/ipsilateral lat flexion
- muscle imbalance
- pain on palpation
- agg: standing, walking
What is a facet joint block?
An injection of local anesthetic and steroids into the joint
What is Spondylosis?
It is a degenerative LBP/disc disease (OA)
What causes spondylosis?
- degenerative disc, facet joint, vertebral body
- ageing and genetics
- micro trauma
- annular tears
- osteophytes
- narrowing disc space
What can be seen clinically in a patient with spondylosis?
- pain & stiff
- limited extension & lateral flexion
- local pain on palpation
- agg: standing & walking
What is Lumbar Spine Stenosis?
Narrowing of the opening in the lower spine
What causes lumbar spine stenosis?
- narrowing spinal canal
- compression spinal nerves
- disc herniation
What can be seen clinically in a patient with lumbar spine stenosis?
- bilateral leg symptoms
- pain on walking
- improved walking gait with stooped posture
- LL weakness
- pain lower back, buttocks, posterior thighs
What is spondylolysis?
It is a defect/stress in the pars interarticularis of the posterior vertebral arch
What causes spondylolysis?
repetitive stress/loads
What can be seen in a patient with spondylolysis?
- usually young athletes
- asymptomatic > symptomatic
- L5 level
- LBP standing and walking
- decreased ROM
What is spondylothesis?
Is a bilateral pars interarticularis defect in which one vertebra slips forward
