7 - SCREENING FOR Lx SPINE & PELVIC

Question 1

LBP
- definition
- why screening matters

Answer 1

Definition of LBP
Chronic primary LBP = pain lasting more than 3 months in Lx, not attributable to identifiable specific disease

Why screening matters
Leading cause of disability worldwide:
- Affects up to 80% of people at least once in lifetime
- In clinical practice: 90-95% of cases are non-specific (common LBP), meaning that 5 -10% related to specific causes (ex: fractures, tumours, infections, inflammatory diseases)
Rise of Direct Access to Physiotherapy:
- In many countries, patients can consult PT without prior medical diagnosis
- Expands PT’s role from treatment to autonomous clinical decision-making
Key message for screening:
- Most LBP cases can be managed conservatively
- Identifying red flags = key to prompt referral & avoiding missed serious conditions

Question 2

3-step decision making too to help clinicians identify serious patho

Answer 2

1) Determine level of concern
2) Decide clinical action
3) Consider pathway for referral if indicated

Question 3

Overview of key red flags

Answer 3

Table

Question 4

Myofascial pain syndrome

Answer 4

Mechanical dysfunction

Table

Question 5

Piriformis syndrome

Answer 5

Mechanical dysfunction

Table

Question 6

Minor intervertebral dysfunction

Answer 6

Mechanical dysfunction

Table

Question 7

Thoracic spinal osteoarthritis

Answer 7

Degenerative disorders

Table

Question 8

Facet joint cysts

Answer 8

Degenerative disorders

Table

Question 9

Lumbar disc herniation

Answer 9

Degenerative disorders

Table

Question 10

Lumbar spinal stenosis

Answer 10

Degenerative disorder

Table

Question 11

Lumbar spondylolisthesis

Answer 11

Degenerative disorder

Table

Question 12

Lumbar scoliosis

Answer 12

Degenerative

Table

Question 13

Maigne’s syndrome

Answer 13

Degenerative

Table

Question 14

DISH

Answer 14

Degenerative

Table

Question 15

Vertebral compression fracture

Answer 15

Traumatic

Table

Question 16

Lumbar vertebral fracture

Answer 16

Traumatic

Table

Question 17

Cauda equina syndrome

Answer 17

Neurological

Table

Question 18

Spondyloarthropathy spectrum

Answer 18

Table

Question 19

Ankylosing spondylitis

Answer 19

Spondyloarthropathy

Table

Question 20

Non-radiographic axial spondyloarthritis

Answer 20

Spondyloarthropathy

Table

Question 21

Undifferentiated spondyloarthritis

Answer 21

Spondyloarthropathy

Table

Question 22

Reactive arthritis

Answer 22

Spondyloarthropathy

Table

Question 23

Pyogenic

Answer 23

Infectious

Pyogenic (bacterial spondylodiscitis)
- Infection of the intervertebral disc and adjacent vertebrae.
-The lumbar spine is the most frequently affected region (~50-60% of cases).
- Symptoms: Constant, deep lumbar pain (not mechanical), often worsening at night, fever, chills (present in
~50% of patients). Neurological signs may appear if abscess or epidural spread occurs

Question 24

Infectious spondylodiscitis

Answer 24

Table

Question 25

Spinal tuberculosis

Answer 25

Infection Spinal Tuberculosis (Pott’s Disease) - Caused by Mycobacterium tuberculosis, often affecting thoracolumbar and lumbar vertebrae. - More indolent than bacterial spondylodiscitis – diagnosis is often delayed. - MRI + lab tests (ESR, CRP, TB-PCR) needed for diagnosis. - Requires anti-tuberculous therapy and sometimes surgical decompression

Question 26

Abdominal aortic aneurysm

Answer 26

Cardiac Table

Question 27

Pancreatitis

Answer 27

Digestive Table

Question 28

Digestive cancers

Answer 28

Digestive Table

Question 29

Pyelonephritis

Answer 29

Uro-genital Table

Question 30

Nephrolithiasis

Answer 30

Uro-genital Table

Question 31

Endometriosis

Answer 31

Uro-genital Table