21: Approach To Thoracolumbar Complaint

Question 1

Risk factors for spina bifida

Answer 1

FHx neural tube defects, folate deficiency, DM, increased body temp, obesity, meds

Question 2

Three types of spina bifida and what they mean

Answer 2

1. Spina bifida occulta: mildest, no sx besides possible patch of hair
2. Meningocele: sac of fluid comes through baby’s back, nervous tissue intact and normal
3. Myelomeningocele: most severe, spinal canal open with membranes and spinal nerves pushed through sac, can cause paralysis/bladder and bowel dysfunction

Question 3

What does meningo mean?

Answer 3

Lining of vertebral canal

Question 4

What does myelo mean?

Answer 4

Spinal cord proper

Question 5

What does cele mean?

Answer 5

Something bulging out

Question 6

Most common form of scoliosis

Answer 6

Adolescent idiopathic scoliosis (AIS)

Question 7

Females with scoliosis

Answer 7

5-10x more likely to progress to severe disease

Question 8

If both parents have AIS…

Answer 8

Offspring 50x more likely to require treatment for scoliosis

Question 9

Why can scoliosis screenings be harmful?

Answer 9

May have referrals and radiographs that lead to significant expense and harm to patient when treatment isn’t even necessary

Question 10

Risser Sign-progression prediction

Answer 10

Shows amount of calcification present in iliac apophysis (grade 1 = low ossification, grade 4 = 1–% ossification, grade 5 = fusion has occurred)

Question 11

How to interpret Risser sign-progression prediction

Answer 11

The lower grade Risser sign means the child has a lot more growth to do, meaning scoliosis is likely to progress more

Question 12

Five red flags for scoliosis

Answer 12

1. Onset before age 8
2. Severe pain
3. Rapid curvature progression (>1 degree per month)
4. Unusual left thoracic curve)
5. Neurological deficits/findings

Question 13

When does the first episode of LBP occur?

Answer 13

Between 20-40 years of age

Question 14

Acute low back pain: definition

Answer 14

6-12 weeks of pain between the costal angles and gluteal folds that may radiate to 1 or both legs

Question 15

Acute low back pain specificity

Answer 15

Acute LBP is often non-specific without a definite cause

Question 16

Most susceptible population for compression fractures

Answer 16

Elderly white females

Question 17

Some historical findings that may lead to believe pt has a compression fracture

Answer 17

1. Significant age-related trauma (strongest)
2. Prolonged steroid use
3. Age 70+, osteoporosis

Question 18

Most common “cause” of compression fractures

Answer 18

Osteoporosis

Question 19

Some causes of herniated nucleus pulposus

Answer 19

Obesity, occupation, genetics, smoking

Question 20

Where do the following injuries refer pain to: spine, sacroiliac joint, lumbar roots

Answer 20

Spine -> refers to thigh
Sacroiliac joint -> refers to thigh, sometimes knee
Lumbar root -> refers to leg

Question 21

L1-L3 nerve root injury vs L4-S1 nerve root injury: where the pain radiations

Answer 21

L1-3: radiates to hip/thigh

L4-S1: radiates below knee

Question 22

Where are 98% of disc herniations?

Answer 22

Between L4/L5, L5/S1

Question 23

Where to test sensation for L4, L5, and S1?

Answer 23

L4: patella
L5: great toe
S1: Achilles, lateral foot

Question 24

Some red flags that may point to cancer in the back

Answer 24

Metastatic cancer, unexplained weight loss, pain increased with rest, vertebral tenderness

Question 25

Red Flags for back pain (with mnemonic)

Answer 25

``` TUNAFISH T: trauma U: unexplained weight loss N: neurologic sx A: age >50 F: fever I: IVDU S: steroid use H: Hx cancer ```

Question 26

Is psoas syndrome common?

Answer 26

No, other conditions such as herniation, arthritis, and sacroiliac pain are much more common

Question 27

What can cause psoas syndrome?

Answer 27

Shortening/injury of iliopsoas, most common in athletes, after sitting for a prolonged time and standing up

Question 28

Anatomical short leg syndrome vs functional short leg

Answer 28

Anatomical: one leg longer, can be corrected with a heel lift Functional: apparent short leg, but structurally both are the same length when measured

Question 29

Two major causes of piriformis syndrome

Answer 29

Anatomical variation, Hx direct trauma to butt

Question 30

How is piriformis Syndrome different from disc herniation?

Answer 30

Piriformis syndrome exacerbated by active external hip rotation

Question 31

Neurogenic claudication

Answer 31

A combo of LBP, leg pain, numbness, and motor weakness that starts/intensifies after walking, eased by lying down

Question 32

Population where spondylosis is most common

Answer 32

Children and adolescents, most common in children/teeens in sports with lots of low back stress

Question 33

What is the most common cause of back pain in teens?

Answer 33

Spondylolisthesis

Question 34

Two examples of CT diseases

Answer 34

RA, SLE

Question 35

General presentation of CT disease

Answer 35

Multiple joint arthralgia, fever, weight loss, fatigue, other joint tenderness

Question 36

Spondyloarthropathies

Answer 36

Forms of arthritis that affects bones and nearby joints

Question 37

General presentation of spondyloarthropathies

Answer 37

Intermittent pain at night, morning pain, inability to reverse from lumbar lordosis to lumbar flexion

Question 38

Three examples of spondyloarthropathies

Answer 38

1. Ankylosing spondylitis 2. Psoriatic arthritis 3. Reactive arthritis

Question 39

Most common form of spondyloarthropathy

Answer 39

Ankylosing spondylitis

Question 40

Most susceptible population to Ankylosing spondylitis

Answer 40

White males between 15-40 years of age

Question 41

What happens in Ankylosing spondylitis

Answer 41

Ossification of annulus fibrosus in lumbar spine from formation of syndesmophytes

Question 42

Scottie Dog is related to what condition?

Answer 42

Spondylolysis

Question 43

Step-off is related to what condition?

Answer 43

Spondylolisthesis

Question 44

Bamboo spine is associated with what condition

Answer 44

Ankylosing spondylitis

Question 45

Most susceptible population for reactive arthritis

Answer 45

Males in late teens/early adulthood

Question 46

Reiter’s syndrome

Answer 46

Spondyloarthropathy with eye, urethra, and joint inflammation