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Ortho > Lower Back Disorders > Flashcards

Lower Back Disorders Flashcards

1
Q

Define Lordosis

A

Increased anterior convexity in the curvature of the spine

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2
Q

Define Kyphosis

A

Exaggeration of posterior convexity of the thoracic vertebral column found commonly with OA & osteoporosis

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3
Q

Define Scoliosis

A

Lateral curve of the spine usually right convex thoracic, most of which are idiopathic

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4
Q

Define Spondylolisthesis

A

Anterior slip, bilateral pars defect

Palpable step off with or without neurological symptoms

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5
Q

Define Stenosis

A

Narrowing of the spinal canal or neural foramen producing root ischemia or neurogenic claudication

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6
Q

Define Spondylolysis

A

Stress fracture of pars interarticularis

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7
Q

What on physical exam may indicate hip joint pathology?

A

Decreased internal rotation or external rotation

Reproduction of pain

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8
Q

L4 Reflex, Motor, and Sensory

A

R: patellar
M: ankle
S: medial foot and leg

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9
Q

L5 Reflex, Motor, and Sensory

A

R: none
M: extensor hallucus longus
S: lateral leg & dorsum of foot

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10
Q

S1 Reflex, Motor, and Sensory

A

R: Achilles
M: peroneus longus & brevis
S: lateral foot

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11
Q

Parts of a Vertebral Disc

A

Nucleus pulposus

Annulus Fibrosis

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12
Q

Ligaments of the Lumbar Spine

A

Anterior longitudinal ligament
Posterior longitudinal ligament
Interspinous
Supraspinous

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13
Q

Where does the anterior longitudinal ligament lie?

A

Anterior surface of the vertebral bodies

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14
Q

Where does the posterior longitudinal ligament lie?

A

Posterior surface of vertebral bodies inside the vertebral canal

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15
Q

What ligaments connect the spinous processes?

A

Interspinous

Supraspinous

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16
Q

Diagnostic Tests for Low Back Pain

A 
Plain radiographs
Bone scan
Diskography
CT myelogram
MRI
Labs
Tests for neurogenic pain
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17
Q

What can a bone scan rule out?

A

Infection

Occult metastatic tumor

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18
Q

What test is an accurate assessment of stenosis?

A

CT Myelogram

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19
Q

What test is the most useful for disc injury?

A

MRI

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20
Q

Which patients should you run labs on for low back pain?

A

High risk

Unimproved after 8-12 weeks of conservative treatment

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21
Q

Patients with High Risk Features for Low Back Pain

A

Poorly controlled DM
Infection
Nursing home
Hx of CA

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22
Q

Symptoms of a Herniated Disc

A

Some degree of back pain
Pain that radiates into the leg
Shooting or stabbing pain

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23
Q

Which is worse: straight leg raise or crossed straight-leg raise?

A

Crossed straight-leg raise

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24
Q

Most Useful Test for Herniated Discs

A

MRI

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25
Q

Treatment for Disc Herniation

A

Conservative: PT, NSAIDs/steroids, & muscle relaxants; epidural steroid injections
Surgical

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26
Q

Reasons for Surgical Treatment of a Disc Herniation

A

Cauda equina syndrome
Profound motor deficits
Progressive neurologic deficit
Persistent bothersome sciatic pain, despite conservative management for 6-12 weeks

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27
Q

Define Spinal Stenosis

A

Spinal canal narrowing with possible subsequent neural compression

28
Q

Causes of Spinal Stenosis

A 
Facet hypertrophy of the vertebra
Vertebral body osteophytes
Ligamentum flavum hypertrophy
Disc degeneration
Neoplasm
Acromegaly
Paget's disease
Ankylosing spondylitis
29
Q

What is neural claudication due to spinal stenosis exacerbated by?

A

Standing erect

Downhill ambulation

30
Q

What is neural claudication due to spinal stenosis alleviated by?

A

Lying supine

Forward flexion

31
Q

Diagnostic Tests for Spinal Stenosis

A

Radiographs
MRI: imaging of choice
Vascular studies if unsure

32
Q

Treatment of Spinal Stenosis

A

PT stressing good spinal flexion
Maintain fitness level
Laminectomy

33
Q

Define Degenerative Disc Disease

A

Disc dries out & loses shock absorption effect

Physiologic event modified by trauma, hereditary, & smoking

34
Q

Management of Degenerative Disc Disease

A

NSAIDs
Back education program
MRI if no relief with above or if neuro symptoms develop

35
Q

Define Facet Syndrome

A

Degenerative Joint Disease of articulating surfaces of vertebrae

36
Q

Diagnostic Test for Facet Syndrome

A

Radiographic diagnosis

37
Q

Treatment of Facet Syndrome

A

NSAIDs
Back education program
Focal injections
Nerve obliteration

38
Q

What is a muscle strain/sprain caused by?

A

Repetitive lifting
Bending
Other trauma

39
Q

Management of Muscle Sprain/Strain

A

NSAIDs
Back education program
Relative rest
Activity modification

40
Q

Cauda Equina Syndrome

A

Mechanism: trauma, spinal cord injury, compression of sacral nerve roots
Urinary retention with neurogenic bladder

41
Q

Evaluation of Cauda Equine Syndrome

A

Rectal tone
Bulbocavernosus reflex
S1, S2, S3
Sacral sparing evaluating perianal sensation

42
Q

Management of Cauda Equine Syndrome

A

REFER

43
Q

Describe Bulbocavernosus Reflex

A

Pull on a catheter that has the balloon inflated

44
Q

Define Ankylosing Spondylitis

A

Chronic & progressive form of seronegative arthritis

45
Q

How does ankylosing spondylitis occur?

A

Formation of bony bridges between adjacent vertebrae

Progressive ossification of extra spinal joint capsules & ligaments

46
Q

Who is most commonly affected with ankylosing spondylitis?

A

Young males

Peak: 15-35 years old

47
Q

Presentation of Ankylosing Spondylitis

A

Repeated episodes of nocturnal back pain

Associated with spinal stiffness in the morning

48
Q

Presenting Sign on Radiographs for Ankylosing Spondylitis

A

Bamboo spine

49
Q

Treatment of Ankylosing Spondylitis

A

Lifelong exercises

NSAIDs

50
Q

Most Common Population for Compression Fractures

A

Osteoporotic elderly

51
Q

Define Burst Fracture

A

Bone shatters into many pieces

52
Q

Describe the Pain in a Compression Fracture

A 
Axial
Non-radiating
Aching
Stabbing
May be severe & disabling
53
Q

What are important neurologic signs for a compression fracture?

A

Lower extremity weakness or numbness

54
Q

Diagnostics for Compression Fractures

A

AP/lateral radiographs

MRI: determine acute from chronic

55
Q

Treatment of Compression Fractures

A

Conservative

Surgical

56
Q

Conservative Treatment of Conservative Fractures

A

Bracing
Analgesic medications
Rest

57
Q

Cause of Scoliosis

A

Genetic in nature

58
Q

What does scoliosis cause?

A

Lateral curvature of the spine greater than 10 degrees away from the central axis

59
Q

Diagnosing Scoliosis

A

Forward flexion test

High sided scapula/shoulder

60
Q

Treatment for Scoliosis less than 25 degrees

A

Observe with serial x-rays over time

61
Q

Treatment for Rapidly Progressing Curves with 20+ Degrees

A

Bracing

62
Q

Treatment for Scoliosis for 20-40 Degrees

A

Bracing

63
Q

Treatment for “Inflexible” curves in Scoliosis

A

Surgery

64
Q

Describe the Cobb Angle

A

Measure of the resulting scoliosis angle based on radiographs

65
Q

Describe Sciatic Pain

A

Shooting, radiating pain down one or both legs usually below the knee/knees in a dermatomal distribution often with associated numbness & tingling possible local weakness

66
Q

Differential Diagnosis of Low Back Pain

A 
Herniated disc
Lumbar strain or sprain
Myofascial pain syndrome (MPS) & fibromyalgia (FM)
Facet syndrome
Ankylosing spondylosis
Spondylolisthesis
Compression fracture
Spinous/transverse process fracture
Sacral stress fracture
Central canal stenosis
Foraminal stenosis
Steersman's disease
Diskitis
Osteomyelitis
Malignancy
AAA
Endometriosis
Prostatitis
SI joint dysfunction
67
Q

Signs/Symptoms of Life Threatening Proportion

A 
Aching nocturnal pain unrelieved by rest
S/S of AAA
Bladder/bowel incontinence
Cauda Equina 
Spine fracture with instability

Ortho (22 decks)

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