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Flashcards in low back pain Deck (32):
1

causes of low back pain

mechanical (anatomic or functional problem): worsened by movement
nonmechanical (chemical irritation from inflammation or infection): pain at rest + movement
non-spinal:

2

most common back pain

lumbar sprain/strain (lumbago):
tear in annulus fibrosus → leak fluid → inflammation, irritate lumbar roots
irritation of muscles, tendons, ligaments, joint capsule
inflammation of lower back → radiate to butt and hamstring
caused by twisting, lifting, overweight

3

sciatica

herniated disk of lumbar region with impingement of nerve root (radiculopathy)
sharp/burning pain (radicular) along sciatic nerve dermatome
pain down back and BELOW knee (if not below knee = non-radicular)
pain worse with: valsalva, cough, bending forward
better with: lying down
positive SLR: sensitive

4

risk factors for herniation

30-55 yo

5

most common herniations

L4-L5
L5-S1

6

acute neurological changes in structures supplied by sacral nerve roots: bowel and bladder dysfunction (urinary retention)
OR perineal anesthesia and BL leg pain = sciatica/weakness
+ SLR, reduced ankle sphincter tone, decreased ankle reflexes

cauda aquina syndrome - surgical emergency

7

most common cause of cauda equina syndrome

large paracentral disk herniation
tumor

8

degenerative changes in spine results in hypertrophy of facet joints + ligamentum flavum → diameter of spinal canal or neural outlets compromised (usually multiple levels)
low back and leg pain/weakness
pain worse with activity (pseudoclaudication), downhill walking, down stairs (extension of spine)
pain improves: bending over, shopping cart, squatting, lying, sitting
causes: degenerative arthritis, spondylolisthesis

spinal stenosis

9

osteoporosis, neoplastic disease, elderly, chronic steroid use is risk factor for

vertebral compression fracture

10

risk factor for osteoporosis

female
early menopause
smoking
sedentery lifestyle
chronic steroid use

11

slow onset of back pain

spinal stenosis - degenerative
ankylosing spondylitis - rheumatologic

12

chronic, constant dull low back pain

cancer

13

electric shock pain - burning

irritated nerve or nerve root

14

low back pain that radiates below knee

herniated disk
spinal stenosis
cauda equina syndrome

15

pain in paraspinal muscles and radiates to butt

lumbar strain

16

lumbar back pain + leg pain increases with activity

spinal stenosis

17

stiffness decreases in 20-30 minutes

disk stiffness

18

stiffness decrease in few hours

ankylosing spondylitis

19

red flags for back pain

neuromotor deficit
unexplained fever
loss of B/B
suspect ankylosing spondylitis
osteoporosis
chronic CS use
immunosuppresion
alcohol abuse, IVDU
> 6 wks duration
cancer:
> 50 yo
personal hx of cancer
unexplained weight loss
pain worse at night
failed conservative therapy after 1 mo

20

straight leg raising test

supine
sensitive for herniated disk - not specific
positive if radicular pain down leg occurs when leg is elevated between 30 and 60 degrees

21

without red flags, treatment of acute low back strain/lumbago

conservative management for 4-6 wks (acetaminophen, NSAIDS, muscle relaxants - may cause sedation)
f/u in 1 month
early mobilization (no more than 2 days of bed rest), PT has short-term benefit
if no recovery after 1 mo or not candidate for surgery/epidural injection: MRI
if no spinal pathology: add PT, exercise
if unresolving herniated disk or spine pathology- refer to spine specialitist

22

treatment of radiculopathy from herniated disk (sciatica)

conservative management (NSAIDS and/or muscle relaxant, activity as tolerated)
improve in 4-6 wks
if radicular radiating pain > 6 wks need MRI

23

low back pain imaging

herniated disc, cauda equina, spinal stenosis: MRI
bony spinal pathology: CT
compression fracture, degenerative, cancer (follow up with MRI/ bone scan): xray

24

bone scan

osteomyletitis
mets
occult fracture

25

management of cauda equina syndrome

lumbar MRI
surgical decompression of entrapped cauda equina

26

fever
direct vertebral tenderness
recent infection
IVDU

osteomyelitis
septic discitis
paraspinous abscess
epidural abscess

27

management of infectious process of low back pain

CBC
ESR
blood culture, abscess culture
CSF
MRI
IV antibiotics +/- I&D

28

diagnostic management of cancer: multiple myeloma, metastatic prostate, breast, lung

CBC
ESR
xray
if abnormal: get MRI and/or bone scan

29

contralateral leg raise

specific for herniated disk

30

treatment of spinal stenosis

conservative management: NSAIDS, PT, epidural CS
surgery: failed conservative or progressive neuro changes

31

acute low back pain after lifting, bending, coughing
pain radiates BL anterior abdomen "girdle of pain"
T12-L2 fracture

vertebral compression fracture

32

treatment of compression fracture

pain control
PT
calcitonin or bisphosphonates and treat underlying OP