Lumbar spine Flashcards
(112 cards)
1
Q
Where do cervical nerve roots exit the spinal canal
A
Above the pedicle of the corresponding vertebrae
2
Q
Where do lumbar nerve roots exit the spinal Canal
A
Below the corresponding pedicle
3
Q
What motor function does T1-T6 control in the body
A
Trunk and intercostals
4
Q
What part of the spine have control of abdominal muscles
A
T7-L1
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
6
Q
What pathology are you most concerned about in regards to the T-Spine
A
Fractures
SCI
Pediatric deformity
Scoliosis
7
Q
What lumbar nerve control hip flexion and hip adduction
A
L2, L3
8
Q
What does the L4 nerve control
A
Patellar reflex
9
Q
What Lumbar motor nerve control ankle dorsiflexion, hip extension, hip abduction
A
L5
10
Q
What does the S1 nerve control
A
Achilles reflex
11
Q
What nerves are in control of sphincter tone
A
S5
12
Q
What does the babinski reflex test
A
A central pathology (brain + spinal cord)
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
14
Q
What is the babinski sign
A
When the toes flex with the babinski test
15
Q
What does sustained ankle clonus indicate
A
Spinal cord pathology
16
Q
What is the FABER test
A
hip Flexed to 90 degrees
ABduct &
Externally
Rotated
17
Q
What is the FABER test used for
A
Differentiate between hip and sacral pain
18
Q
If there is back pain for the FABER test, what is it indicative of
A
SI joint dysfunction
19
Q
If there is groin pain with the FABER test, what is it indicative of
A
Hip pathology
20
Q
What are some lumbosacral tests
A
Faber
Straight leg raise
21
Q
What is a positive straight leg raise
A
Having radicular pain between 30-70 degrees of hip flexion
22
Q
What is the gold standard for diagnosing back pain
A
MRI
23
Q
When is MRI with contrast used for confirming back pain diagnosis
A
Had previous surgery
suspicion / Hx of cancer
Concern of infection
24
Q
When can an MRI be ordered for back pain
A
Failure of at least 1 month of conservative management
25
What are red flags that allow for immediate MRI for back pain
Cauda Equina sx
H/O IVDU
associated fever/chills
H/O or concern for cancer
H/O trauma
26
What test is ordered if an MRI with contrast can not be done
CT angio
27
What test can help pinpoint which nerve or pathway is compressed
EMG / NCV
28
What is the treatment buffet for back pain
Heat / rest/ ice
PT / home exercise
Alternative treatment
Bracing (peds only)
Medications
injections
surgery
29
Why is bracing avoided in adults when there is no deformity or fracture
Chronic brace use can exacerbate pain descondary to reconditioning
30
What is the top pain medication to recommend for patients with back pain
Tylenol (acetaminophen)
31
Which anti-inflammatories can someone take with back pain
Aleve / Advil
Diclofenac, meloxicam, etodolac, indomethacin
Celecoxib
32
When are NSAIDs contraindicated for patients
CKD
DM
Caution for heart disease
33
What medications can be given for nerve pain
gabapentin
Pregabalin
34
What is important to remember if gabapentin is prescribed
There are many side effects
Cannot stop abruptly - must wean
-> lowers seizure potential
35
When can pregabalin be prescribed
After a failed trail with gabapentin
36
What type of muscle relaxers can be prescribed for patients
Cyclobenzaprine
methocarbamol
tizanidine
Carisoprodol (soma)
Benzodiazepines
37
What are some types of Benzodiazepines
Valium / Diazepam
Alproxolam / Xanax
38
What are controlled substance muscle relaxers
Carisoprodol(soma)
Benzodiazepine
39
What are side effects with muscle relaxers
Respiratory depression, especially with concurrent pain meds / elderly patients
40
What type of medications help with night time nerve pain
Nortriptyline
TCA medication
* both are tricyclic antidepressants
41
What do you have to be careful with / aware of with trycyclic antidepressants
Can OD on these
42
What antidepressants can be prescribed for chronic pain
SNRI
Duloxetine
43
What steroids can you use for acute pain
Methylprednisolone
44
What is important to remember when prescribing steroids
Must taper the dose - don't stop abruptly
45
What is the perk of using methylprednisolone
A medrol dose pack is already tapered for you
46
Which patients have poor outcomes with surgery on LSpine
Nicotine use
Uncontrolled DM
BMI > 40
Chronic narcotic use
47
How will a lumbar sprain present
Deep steady pain in the low back -> often with overuse
48
How long should it take a lumbar strain to resolve
6 weeks -> if still in pain, investigate with imaging and more tests
49
What is another name for degenerative disc disease
Spondylosis
50
What is axial low back pain
Pain that remains in lower back
51
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
degenerative disc disease
52
What is the first line imaging for spondylosis
Xray
53
What is the diagnostic test of choice for DDD
MRI
54
Is radiculopathy a symptom or a diagnosis
Symptom
55
What is radiculopathy
nerve root irritation
56
What is radiculopathy of the sciatic nerve called
sciatica
57
What is sciatica often secondary to
Herniated disc
58
What nerves come together to form the sciatic nerve
L4 - S3
59
What exam will be positive with sciatica
Straight leg raise
*must differentiate from muscular pain
60
Which gender is more apt to get a herniated disc
Men 2:1
61
What causes a herniated disc
a tear in the annulus that allows for the nucleus to leak out
62
What level of the L-spine is most often to see a herniated disc in
L4-5
L5-S1
63
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
Herniated disc
64
What can increase pain with a herniated disc in a physical exam
Coughing
sneezing
valsalva
65
What is the diagnostic modality of choice for herniated discs
MRI
66
If conservative treatment fails with herniated discs, what is the next line of treatment
Discectomy
67
How long does it take for a patient to start to feel better with a herniated disc
roughly 3 months
68
What is spinal stenosis
Narrowing of the spinal canal
69
What else is generally occurring with spinal stenosis
foramen stenosis
70
What is the #1 reason for spine surgery in patients >65y/o
spinal stenosis
71
What area of the spine do you most commonly see spinal stenosis
L4-L5
72
What is claudication
Fatiguability
73
What is the hallmark of lumbar stenosis
Neurogenic claudication
74
What is the diagnostic test of choice for spinal stenosis
MRI
75
What is spondylolysis
Defect in the pars
76
What makes up about 50% of adolescent back pain
Spondylolysis
77
What are the risk factors for spondylolysis
Repetitive hyperextension
Contact sports
78
What can spondylolysis lead to
spondylolisthesis
79
Where is spondylolysis typically seen
L5-S1
80
What symptoms do patients generally have IF they have symptoms with spondylolysis
Insidious onset back pain, worse with activity
81
What will you see in a physical exam with someone who has spondylolysis
Limited lumbar flexion/extension
Pain with single leg lumbar extension
82
What imaging is useful for delineating spondylolysis
CT
83
What is the most sensitive test for Spondylolysis
Bone scan
84
If a patient has progressed to spondylolisthesis or has refractory pain, what is the treatment option
Lumbar fusion
85
What grade of spondylolisthesis is seen with complete dissociation
Grade 5
86
What is the first line of diagnostic tests is used for spondylolisthesis
Xray
87
What is ankylosing spondylitis
Inflammatory condition of the spine
88
Who is usually at higher risk of developing ankylosing spondylitis
Caucasian males
89
What gene is associated with ankylosing spondylitis
HLA-B27
90
What is occurring in the spine with ankylosing spondylitis
Soft tissue ossification
Surrounding bone erosion
91
With is the diagnostic criteria for ankylosing spondylitis
Bilateral sacroilitis
Uveitis or Iritis
+HLA-B27
92
What does the Schober test measure
Spine ROM
-If no expansion with forward flexion-> positive test
93
What will ankylosing spondylitis look like on imagining
Bamboo spine
SI joint narrowing
Generalized osteopenia
94
What test can confirm sacroilitis in ankylosing spondylitis
SI joint corticosteroid injection
95
What will lab tests look like with ankylosing spondylitis
+HLA-B27
neg RF factor
Elevated ESR/CRP
96
how do you usually treat ankylosing spondylitis
Symptomatic treatment with TNF inhibitors
97
What gender and curvature is most common with scoliosis
Females
Right thoracic curvature
98
What is diagnostic on X-rays for scoliosis
>10 degree Cobb angle
99
What scoliosis angle in growing kids is treated with surgery
>60
100
What scoliosis angles in growing kids is surgery considered
50-60 degrees and symptomatic patients
101
What scoliosis curvature requires bracing in growing children
30-50 degrees
102
What skeletal angles in adults do you consider surgery
50 + degrees or if they're symptomatic
103
What is cauda equina
Compression of cauda equina, in the L1-S5 region
104
What is the most common cause of cauda equina
Large disc herniations
105
Which gender and level is most common to have cauda equina syndrome
Males
L4-L5
106
What will cauda equina syndrome cause
Bowel / bladder dysfunction
Saddle anesthesia
107
Which patients are at higher risk for osteomyelitis
IVDU
Poorly controlled DM
Obese
Smokers
Immunosuppressed
108
What is the best imaging modality to diagnose osteomyelitis
MRI with contrast
109
When is surgical intervention needed with osteomyelitis
Unable to obtain IR bx
Abcess drain needed
Significant persistent deformity
110
How do you confirm an epidural access diagnosis
MRI with contrast
111
What is the treatment for an epidural abscess
emergent surgical decompression and send a culture and sensitivity
112
What will you see on labs in someone with an epidural abscess
Elevated WBC, ESR and CRP along with Bacteremia
