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MSK clin Med > Lumbar spine > Flashcards

Lumbar spine Flashcards

1
Q

Where do cervical nerve roots exit the spinal canal

A

Above the pedicle of the corresponding vertebrae

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2
Q

Where do lumbar nerve roots exit the spinal Canal

A

Below the corresponding pedicle

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3
Q

What motor function does T1-T6 control in the body

A

Trunk and intercostals

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4
Q

What part of the spine have control of abdominal muscles

A

T7-L1

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5
Q

Why is it hard to determine which nerve is effected when located in the T-Spine

A

Overlying dermatoses make it hard to differentiate

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6
Q

What pathology are you most concerned about in regards to the T-Spine

A

Fractures
SCI
Pediatric deformity
Scoliosis

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7
Q

What lumbar nerve control hip flexion and hip adduction

A

L2, L3

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8
Q

What does the L4 nerve control

A

Patellar reflex

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9
Q

What Lumbar motor nerve control ankle dorsiflexion, hip extension, hip abduction

A

L5

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10
Q

What does the S1 nerve control

A

Achilles reflex

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11
Q

What nerves are in control of sphincter tone

A

S5

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12
Q

What does the babinski reflex test

A

A central pathology (brain + spinal cord)

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13
Q

What does a normal babinski test look like

A

Run a sharp instrument from heel to toe
- a normal test = flexion of toes

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14
Q

What is the babinski sign

A

When the toes flex with the babinski test

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15
Q

What does sustained ankle clonus indicate

A

Spinal cord pathology

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16
Q

What is the FABER test

A

hip Flexed to 90 degrees
ABduct &
Externally
Rotated

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17
Q

What is the FABER test used for

A

Differentiate between hip and sacral pain

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18
Q

If there is back pain for the FABER test, what is it indicative of

A

SI joint dysfunction

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19
Q

If there is groin pain with the FABER test, what is it indicative of

A

Hip pathology

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20
Q

What are some lumbosacral tests

A

Faber
Straight leg raise

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21
Q

What is a positive straight leg raise

A

Having radicular pain between 30-70 degrees of hip flexion

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22
Q

What is the gold standard for diagnosing back pain

A

MRI

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23
Q

When is MRI with contrast used for confirming back pain diagnosis

A

Had previous surgery
suspicion / Hx of cancer
Concern of infection

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24
Q

When can an MRI be ordered for back pain

A

Failure of at least 1 month of conservative management

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25
Q

What are red flags that allow for immediate MRI for back pain

A

Cauda Equina sx
H/O IVDU
associated fever/chills
H/O or concern for cancer
H/O trauma

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26
Q

What test is ordered if an MRI with contrast can not be done

A

CT angio

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27
Q

What test can help pinpoint which nerve or pathway is compressed

A

EMG / NCV

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28
Q

What is the treatment buffet for back pain

A

Heat / rest/ ice
PT / home exercise
Alternative treatment
Bracing (peds only)
Medications
injections
surgery

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29
Q

Why is bracing avoided in adults when there is no deformity or fracture

A

Chronic brace use can exacerbate pain descondary to reconditioning

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30
Q

What is the top pain medication to recommend for patients with back pain

A

Tylenol (acetaminophen)

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31
Q

Which anti-inflammatories can someone take with back pain

A

Aleve / Advil
Diclofenac, meloxicam, etodolac, indomethacin
Celecoxib

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32
Q

When are NSAIDs contraindicated for patients

A

CKD
DM
Caution for heart disease

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33
Q

What medications can be given for nerve pain

A

gabapentin
Pregabalin

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34
Q

What is important to remember if gabapentin is prescribed

A

There are many side effects
Cannot stop abruptly - must wean
-> lowers seizure potential

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35
Q

When can pregabalin be prescribed

A

After a failed trail with gabapentin

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36
Q

What type of muscle relaxers can be prescribed for patients

A

Cyclobenzaprine
methocarbamol
tizanidine
Carisoprodol (soma)
Benzodiazepines

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37
Q

What are some types of Benzodiazepines

A

Valium / Diazepam
Alproxolam / Xanax

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38
Q

What are controlled substance muscle relaxers

A

Carisoprodol(soma)
Benzodiazepine

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39
Q

What are side effects with muscle relaxers

A

Respiratory depression, especially with concurrent pain meds / elderly patients

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40
Q

What type of medications help with night time nerve pain

A

Nortriptyline
TCA medication
* both are tricyclic antidepressants

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41
Q

What do you have to be careful with / aware of with trycyclic antidepressants

A

Can OD on these

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42
Q

What antidepressants can be prescribed for chronic pain

A

SNRI
Duloxetine

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43
Q

What steroids can you use for acute pain

A

Methylprednisolone

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44
Q

What is important to remember when prescribing steroids

A

Must taper the dose - don’t stop abruptly

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45
Q

What is the perk of using methylprednisolone

A

A medrol dose pack is already tapered for you

46
Q

Which patients have poor outcomes with surgery on LSpine

A

Nicotine use
Uncontrolled DM
BMI > 40
Chronic narcotic use

47
Q

How will a lumbar sprain present

A

Deep steady pain in the low back -> often with overuse

48
Q

How long should it take a lumbar strain to resolve

A

6 weeks -> if still in pain, investigate with imaging and more tests

49
Q

What is another name for degenerative disc disease

A

Spondylosis

50
Q

What is axial low back pain

A

Pain that remains in lower back

51
Q

If a patient presents with axial low back pain for >12 weeks that is exacerbated by specific positions and movements, what might this patients diagnosis be

A

degenerative disc disease

52
Q

What is the first line imaging for spondylosis

A

Xray

53
Q

What is the diagnostic test of choice for DDD

A

MRI

54
Q

Is radiculopathy a symptom or a diagnosis

A

Symptom

55
Q

What is radiculopathy

A

nerve root irritation

56
Q

What is radiculopathy of the sciatic nerve called

A

sciatica

57
Q

What is sciatica often secondary to

A

Herniated disc

58
Q

What nerves come together to form the sciatic nerve

A

L4 - S3

59
Q

What exam will be positive with sciatica

A

Straight leg raise

*must differentiate from muscular pain

60
Q

Which gender is more apt to get a herniated disc

A

Men 2:1

61
Q

What causes a herniated disc

A

a tear in the annulus that allows for the nucleus to leak out

62
Q

What level of the L-spine is most often to see a herniated disc in

A

L4-5
L5-S1

63
Q

A patient comes in with axial back pain with radicular complaints. They are unable to get comfortable in a chair and are more comfortable standing/walking. Recall a BLT event when the symptoms began. What is the likely diagnosis

A

Herniated disc

64
Q

What can increase pain with a herniated disc in a physical exam

A

Coughing
sneezing
valsalva

65
Q

What is the diagnostic modality of choice for herniated discs

A

MRI

66
Q

If conservative treatment fails with herniated discs, what is the next line of treatment

A

Discectomy

67
Q

How long does it take for a patient to start to feel better with a herniated disc

A

roughly 3 months

68
Q

What is spinal stenosis

A

Narrowing of the spinal canal

69
Q

What else is generally occurring with spinal stenosis

A

foramen stenosis

70
Q

What is the #1 reason for spine surgery in patients >65y/o

A

spinal stenosis

71
Q

What area of the spine do you most commonly see spinal stenosis

A

L4-L5

72
Q

What is claudication

A

Fatiguability

73
Q

What is the hallmark of lumbar stenosis

A

Neurogenic claudication

74
Q

What is the diagnostic test of choice for spinal stenosis

A

MRI

75
Q

What is spondylolysis

A

Defect in the pars

76
Q

What makes up about 50% of adolescent back pain

A

Spondylolysis

77
Q

What are the risk factors for spondylolysis

A

Repetitive hyperextension
Contact sports

78
Q

What can spondylolysis lead to

A

spondylolisthesis

79
Q

Where is spondylolysis typically seen

A

L5-S1

80
Q

What symptoms do patients generally have IF they have symptoms with spondylolysis

A

Insidious onset back pain, worse with activity

81
Q

What will you see in a physical exam with someone who has spondylolysis

A

Limited lumbar flexion/extension
Pain with single leg lumbar extension

82
Q

What imaging is useful for delineating spondylolysis

A

CT

83
Q

What is the most sensitive test for Spondylolysis

A

Bone scan

84
Q

If a patient has progressed to spondylolisthesis or has refractory pain, what is the treatment option

A

Lumbar fusion

85
Q

What grade of spondylolisthesis is seen with complete dissociation

A

Grade 5

86
Q

What is the first line of diagnostic tests is used for spondylolisthesis

A

Xray

87
Q

What is ankylosing spondylitis

A

Inflammatory condition of the spine

88
Q

Who is usually at higher risk of developing ankylosing spondylitis

A

Caucasian males

89
Q

What gene is associated with ankylosing spondylitis

A

HLA-B27

90
Q

What is occurring in the spine with ankylosing spondylitis

A

Soft tissue ossification
Surrounding bone erosion

91
Q

With is the diagnostic criteria for ankylosing spondylitis

A

Bilateral sacroilitis
Uveitis or Iritis
+HLA-B27

92
Q

What does the Schober test measure

A

Spine ROM
-If no expansion with forward flexion-> positive test

93
Q

What will ankylosing spondylitis look like on imagining

A

Bamboo spine
SI joint narrowing
Generalized osteopenia

94
Q

What test can confirm sacroilitis in ankylosing spondylitis

A

SI joint corticosteroid injection

95
Q

What will lab tests look like with ankylosing spondylitis

A

+HLA-B27
neg RF factor
Elevated ESR/CRP

96
Q

how do you usually treat ankylosing spondylitis

A

Symptomatic treatment with TNF inhibitors

97
Q

What gender and curvature is most common with scoliosis

A

Females
Right thoracic curvature

98
Q

What is diagnostic on X-rays for scoliosis

A

> 10 degree Cobb angle

99
Q

What scoliosis angle in growing kids is treated with surgery

A

> 60

100
Q

What scoliosis angles in growing kids is surgery considered

A

50-60 degrees and symptomatic patients

101
Q

What scoliosis curvature requires bracing in growing children

A

30-50 degrees

102
Q

What skeletal angles in adults do you consider surgery

A

50 + degrees or if they’re symptomatic

103
Q

What is cauda equina

A

Compression of cauda equina, in the L1-S5 region

104
Q

What is the most common cause of cauda equina

A

Large disc herniations

105
Q

Which gender and level is most common to have cauda equina syndrome

A

Males
L4-L5

106
Q

What will cauda equina syndrome cause

A

Bowel / bladder dysfunction
Saddle anesthesia

107
Q

Which patients are at higher risk for osteomyelitis

A

IVDU
Poorly controlled DM
Obese
Smokers
Immunosuppressed

108
Q

What is the best imaging modality to diagnose osteomyelitis

A

MRI with contrast

109
Q

When is surgical intervention needed with osteomyelitis

A

Unable to obtain IR bx
Abcess drain needed
Significant persistent deformity

110
Q

How do you confirm an epidural access diagnosis

A

MRI with contrast

111
Q

What is the treatment for an epidural abscess

A

emergent surgical decompression and send a culture and sensitivity

112
Q

What will you see on labs in someone with an epidural abscess

A

Elevated WBC, ESR and CRP along with Bacteremia

MSK clin Med (12 decks)

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