Lumbar Spine Flashcards by Jon Frikken

What is the lifetime prevalence of LBP?

85%

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What are indications for low back surgery?

-Cauda Equina Syndrome
-Trauma resulting in gross instability
-Stable Fractures
-Herniated Disc
-Spinal Stenosis

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What are the emergent surgical conditions for low back pain?

-Cauda Equina Syndrome
-Trauma resulting in gross instability

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What is a spinal decompression surgery?

Removal of bone or neural material suspected to be impinging upon nerves

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What is left for stability with a laminectomy?

Just facets, unless hardware included

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What should be limited s/p discectomy?

-Bending
-Twisting
-Sitting >30 minutes

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What should be limited with laminectomy?

-Bending
-Twisting
-Sitting

All “as tolerated”

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What is a typical exercise program for weeks 2-4 after lumbar decompression?

-Ankle Pumps
-Quad, Glute, Ham sets
-SAQ
-LAQ
-Midline stabilization
-Treadmill as tolerated

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What manual therapy may be used after lumbar decompression surgery?

Soft Tissue Mobilization

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What positioning and postural education should be performed after lumbar decompression?

-Use Lumbar roll
-Neutral posture

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At what point to initiate lifting exercises with an individual after spinal decompression surgery?

5-12 weeks, progress from 0 to 15-20#

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What is the goal timeframe for returning an individual back to prior level of function after spinal decompression surgery?

6 months

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What are the dos and don’ts of total disk replacement?

-No rotation of the lumbar region for the first 3 weeks
-No curving of the lumbar region for the first 6 weeks
-No intense ab exercises for 6 weeks
-No participation in competitive sports for the first 6 months
-Avoid lifting, twisting, and hyperextending for the first 6 weeks
-Try to keep back straight
-Can swim after 6 weeks
-Can jog after 6 weeks
-Can drive after 2 weeks

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What is the evidence for activity restriction after lumbar disc surgery (nucleoplasty)?

No evidence activities need to be restricted; wait 4-6 weeks for intensive exercise programs

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What is the most common cancer to metastasize to the lumbar spine?

Prostate

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What are medical screening questions for cancer/back-related tumor?

-Prior hx
-Neurologic symptoms
-Unexplained weight loss
-Not improved over 1 month
-Age >50
-No relief with bed rest
-Insidious onset

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What are signs of back-related spinal infection?

-LB, flank, or pelvic pain
-Local tenderness over spinal process with percussion
-Concurrent infection or drug use
-Fever

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What are the items indicitive of cauda equina syndrome?

-Urine retention
-Saddle anaesthesia
-Sensory or motor deficits in the feet

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What are features of a spinal compression fracture?

-Major trauma
-Pain and tenderness
-Age >50
-Female

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What are signs of an abdominal aortic aneurysm?

-Midline lower thoracic/lumbar pain
-Palpable pulsating abdominal mass
-Patient unable to find a comfortable position
-History of cigarette smoking
-Positive family history
-History of AAA or vascular atherosclerotic disorders

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Palpable mass in the abdomen wound indicate performing what next?

Ascultating for a bruit or chaotic sounding blood flow

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What are key factors of ankylosing spodylitis?

-Morning stiffness >30 minutes
-Improvment in LBP with exercise but not rest
-Night pain during second half of night only
-Alternating buttock pain

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What items would clue you in that back pain is musculoskeletal in origin and not GI related?

-worse with coughing, sneezing, taking a deep breath
-Bending, sitting, lifting, twisting, or turning over in bed make the pain feel worse
-No change in bowel habit
-No change with eating certain foods
-No weight change

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To question whether renal or urinary disorders may be contributing to low back pain, what questions to ask?

-Do you have trouble with urination?
-Any changes in urine color, initiation of stream, incontinence, flow changes (in frequency, urgency, output, volume, retention, pain).

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What are the 3 subsystems coordinating for spinal stability?

-Passive/Spinal column -Active/Spinal muscles -Control/Neural

Spinal stability contributes to?

-Protection of spinal cord -Upright posture -Transmit weight to lower members

Spinal mobility contributes to?

-Acting as a shock absorber -Provides motion for head and trunk -Attachments for muscles and ligaments

How much fluid content of discs is lost each day?

25%

When is the load on zygapophysial joints the most?

With loaded lordotic posture

What is the lumbosacral angle?

Usually 30 degrees; angle of sacral base

What will increase shear forces at the lumbosacral joint?

Increased lumbar lordosis

How is vertebral motion described?

As the superior segment moving on the inferior and in the direction of the anterior surface of the vertebral body

According to Fryette's laws of vertebral motion, in neutral, coupled motions are?

Opposite Lateral flexion in one direction is accompanied by rotation to the other

According to Fryette's laws of vertebral motion, in non-neutral, coupled motions are?

Same Lateral flexion in one direction is accompanied by rotation to the same

With rotation, which side of the facet joint is gapped?

The ipsilateral side

What is important regarding the neuromuscular system and injury?

Failure to regain neuromuscular control may place the patient at risk for re-injury

If having pain at midrange, which structures to think of with pain?

Muscles

If having pain at end ranges, think of what structures with low back pain?

Passive structures

What is the order of the spondys from least to most pathological?

-losis -Lysis -listhesis

What things clue you into RA, Ankylosing SPonylitis, Psoriatic Arthritis, etc?

-Multiple joint issues -Skin issues (psoriatic) -Abnormal lab values (C-reactive protein and Erythrocyte sedimentation rate) -Medications such as long term steroids, immunosuppresants

What are symptoms of cauda equina?

-B leg symptoms -Saddle anesthesia -Bowel/bladder changes -May be vague or intermittent symptoms

What is an alternative to ankle dorsiflexion to screen the L4 myotome?

Ankle inversion

What is another way to screen the S1 dermatome besides ankle plantarflexion?

Hip Extension

Is a SLR sensitive or specific for a herniated nucleus pulposus?

Sensitive

Is a cross SLR sensitive or specific for herniated nucleus pulposus?

Specific

What do you need in addition to pain down the leg to be considered a radiculopathy?

One of dermatomal, myotomal, and reflex findings

What can cause pain mimicing radicular pain?

Facet joint pain (no myo, dermo, reflex findings)

What is the minimum to clear the hip with a low back patient?

-Observe gait -PROM with overpressure -Scour test

What has higher evidence? TBC or McKenzie?

TBC

What are the 3 rehabilitation approaches in the 2015 revision of the TBC?

-Symptom Modulation -Movement Control -Functional Optimization

How many visits does it take to reduce low back pain by 50% with manipulation?

In general, when to use manipulation with low back pain?

In acute cases unless not indicated

In general, when to use mobilization?

To address movement impairments, particularly stiff joints in aging patients

What has higher evidence for low back pain, Thrust or nonthrust mobliization or soft tissue mobilization?

Thrust or nonthrust mobilization

What level of evidence does dry needling have on low back pain?

What level of evidence does directional preference have?

What is actually the problem in individuals needing "spinal stabilization"?

Neuromuscular control

What happens with "spinal instability?"

When the deep muscles aren't firing they way they should, the bigger muscles start to overreact

What does the multifidus do?

-Extension -Control of anterior translation and rotatoin during flexion

What muscles fire with side lifts?

-Quadratus lumborum -Multifidus -External Oblique -Internal Oblique

What are issues of the hip that generally go along with regional interdependence of back issues?

-Weak glute med -Inhibited Glute Max -Tight Rec FEm -Tight Iliopsoas -Tight Hamstrings

When is exercise given the highest evidence with low back pain?

Wtih chronic low back pain

Education gets what level of evidence for chronic low back pain?

What is the order of SIJ tests?

-if distraction and thigh thrust tests are negative -then compression test -If the compression test is negative, then the sacral thrust test