Ch. 13 - Low back pain and leg pain Flashcards Preview

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Flashcards in Ch. 13 - Low back pain and leg pain Deck (28):
1

What is the critical factor in assessing pts with low back pain?

Whether there are features of lumbosacral nerve root compression

2

What is sciatica?

Clinical description of pain in leg 2/2 lumbosacral nerve root compression

3

Most common cause of sciatica

Lumbar disc prolapse causing nerve root compression Other: osteophyte compression, lumbar canal stenosis, spondylolithesis

4

Most common level of lumbar disc prolapse

L5/S1

5

Components of interverterbal disc

Internal nucleus pulposus surrounded by annulus fibrosus (external laminar fibrous container)

6

Disc prolapse is most common in what direction?

Posterolateral direction b/c posterior longitudinal ligament prevents direct posterior herniation

7

An L4/5 POSTEROLATERAL disc prolapse will compress which nerve root?

L5

8

An L5/S1 POSTEROLATERAL disc prolapse will compress which nerve root?

S1

9

An L4/5 LATERAL disc prolapse will cause compression of which nerve root?

L4

10

Describe the different types of disc prolapse

Q image thumb

A) Posterolateral disc prolapse -> compression of nerve root below

B) Lateral disc prolapse -> compression of nerve root above

11

Features of L5/S1 disc prolapse

Pain along posterior thigh with radiation to heel

Plantar flexion weakness

Lateral foot sensory loss

Absent ankle jerk

12

Features of L4/5 disc prolapse

Pain along posterior or posterolateral thigh with radiation into dorsum of foot and great toe

Dorsiflexion weakness

Decreased sensation of dorsum of foot and great toe

No reflex changes

13

Features of L3/4 disc prolapse

Pain in anterior thigh

Quadricep (with quadricep wasting) and dorsiflexion weakness

Decreased sensation over anterior thigh, kknee, and medial aspect of lower leg

Reduced knee jerk

14

Innervation of hip flexors? Extensors?

Flexors - L1, 2, 3

Extensors - L5, S1

15

Innervation of knee flexors? Extensors?

Flexors - L5, S1

Extensors - L3, 4

16

Innervation of ankle dorsiflexors? Plantar flexors?

Dorsiflexors - L4, 5

Plantar flexors - S1, 2

17

How long do most cases of back and leg pain take to resolve?

7-10 days

18

What should you order for evaluation of back/leg pain?

X-ray to diagnose associated spondylolisthesis and exclude sinister pathology (e.g. spinal mets)

ESR to exclude systemic dx

19

What are the indications for surgical intervention in disc prolapse?

Incapacitating pain, continuing episodes of recurrent pain, neurologic deficit (e.g. weakness), bilateral sciatica (suggests central disc prolapse), tumor

20

Imaging study of choice for disc prolapse?

MRI

21

Surgical options for lumbar disc prolapse

Usually partial laminectomy + disc excision

Percutaneous lumbar discectomy (remove nucleus pulposus) for 'bulging' disc

 

22

Criteria that suggest better results following disc prolapse surgery

Good hx of sciatica, good signs of nerve root irritation, evidence of herniated disc, nerve root stretched by disc at time of surgery, pt is motivated

23

Characteristic feature of lumbar canal stenosis

Pain is relieved with sitting ('shopping cart' sign)

24

What are the most common levels affected by lumbar canal stenosis?

L4/5 and L3/4

25

Surgical tx of lumbar canal stenosis

Decompressive lumbar laminectomy

26

What intra-abdominal pathology should be considered in a patient with back pain?

Pancreatic dx - pancreatitis or tumors

Aortic aneurysm

Renal dx - calculus, infection, tumor

27

What is spondylolisthesis?

Subluxation of one vertebral body on another (usually L4 or L5); can be congenital or 2/2 degenerative changes

28

Tx of spondylolisthesis

Conservative therapy, laminectomy +/- spinal fusion

Symptomatic patients with grade 2 or above slip have a clear benefit with surgery!