LBP Dx and Tx (Guest Lecture) Flashcards Preview

PTRS 845 Midterm > LBP Dx and Tx (Guest Lecture) > Flashcards

Flashcards in LBP Dx and Tx (Guest Lecture) Deck (20):

Etiology of LBP

1. Mechanical (80-90%)

2. Neurogenic (5-15%)

3. Other (Fibro, Malingering - 2-4%)

4. Referred Visceral Pain (1-2%)

5. Non-mechanical Spinal Conditions (1-2%)



Describe the most common system illness and what condition it is associated with

Vertebral fx associated with osteoporosis


Condition: Represents a pathologic state in which the function of the spinal nerve roots is affected

Lumbar Radiculopathy


Condition: Consists of radicular pain in a dermatomal distribution in combination with N/T and motor weakness

Lumbar Radiculopathy


3 Mechanisms behind radicular pain

1. HNP causing structural and functional changes to adjacent nerve roots leading to sensitization

2. Nerve root compression and stimulation of nociceptors

3. Inflammation and vascular compromise


Sx. of Radicular Pain (3)

1. Sharp, shooting, electrical pain

2. Leg pain worse than back pain

3. Radiation below the knee 


Describe what the seated position allows you to differentiate between

Sitting increases disc sx and decreases stenosis sx


Describe the difference between neuropathic and facet pain

Neuropathic = burning, sharping, nawing

Facet = dull, pressure, achy 


Describe the advantage of the new FM criteria

It provides a graded scale on which to dx FM and can be used to gage pt. outcomes following tx


Describe when CT and MRI would be used

MRI - better for soft tissue; impingements, discs

CT - better for bone; facets, non-union of fx


Describe the difference in appear of discs with degeneration on MRI

Degenerated discs lack a white middle on imaging.  A healthy disc has a white middle indicating the fluid is still present


Pharmocological options for LBP (4)

1. Steroids (if they benefit from pills may benefit from an injection)


3. Muscle Relaxants (taken constantly can weaken mm)(

4. Opioids (high risk of addiction)


Describe the effect of epidural injections and conditions that they can help

The hope is to decrease the inflammation 

Good for: HNP, stenosis, spondys


(Typically not given unless back AND leg pain is present)


Describe the difference between a translaminar, transforaminal, and caudal epidural steroid injections

Translaminar is less controlled, the steroid has a wider spread and will follow the path of least resistance

Transforaminal allows the steroid to be directed at a specific nerve root

Caudal is the simplest and provides wide spread that may not reach the affected level


4 Complications of injections

1. Direct needle trauma

2. Ischemic injury (chance of permanent paralysis is anterior spinal artery clogged)

3. Infection

4. Drug reaction (particulate steroids have a chance of paralysis)


Describe the steroid injection timeline

3 injections over 3-5 mo

Most pts. will need more than one injection for sustained benefit


Describe the difference between spinal cord stimulation and radiofrequency ablation 

Spinal cord stimulation: alleviated pain by electrically activating pain-inhibiting neuronal circuits in the DH and inducing a tingling sensation to make the pain -- uses GATE CONTROL THEORY

Radiofrequency ablation: severing the medial branches that innervate the facets in order to block the pain signals


Condition: Lumbar axial pain that may refer to the LE, pain increased with extension and lateral rotation

Lumbar Facet Arthropathy


Condition: Pain with referred pain along the joint line and ipsilateral hip/trochanter, can also refer along posterior thigh to knee, and can resemble lumbar disc pathology



Condition: Compression of the sciatic nerve, typically presents with similar presentation to L5/S1, LBP/Buttock pain radiation now the posterior thigh/leg

Piriformis syndrome