Lumbar spine Flashcards
(77 cards)
Defining characteristics of cauda equina syndrome
Risk factors: herniated discs, acute rapid onset, lumbar stenosis, chronic/gradual onset, spinal surgery
Presentation: back pain with saddle anesthesia, bowel and bladder disturbances, unilateral symptoms progressing to bilateral, alternating leg pain, presence of new motor weakness, greater than 50 years old
Signs and symptoms of cauda equina
Bowel and bladder disturbances, alternating leg pain, saddle anesthesia, unilateral/bilateral radicular pain dermatome and myotome changesWhy is acute or extreme and rapid onset of lower back pain in adults older than 50 a red flag
Why is acute or extreme and rapid onset of lower back pain in adults older than 50 a red flag
Large discs typically do not cause issues in older adults. Suspect cauda equina syndrome
Fracture of lumbar spine risk factors
Severe trauma
female
Advanced age: > 65 years old female > 75 years old male previous spinal fracture especially with low impact
Frequent use of corticosteroids (75 mg over for three months)
cancer
osteoporosis
severe falls
What is the vertebral compression fracture CPG
Female
Greater than 70 years
Significant trauma in younger old populations
Prolonged corticosteroid use
3/4 equals 100% specificity
What are signs that you would look for an exam to encourage referral to imaging? What Type of imaging?
Use of CPG in addition to:
midline tenderness to palpation (can be below fracture area) neurological signs
spinal deformity
contusion or abrasion if sustained from fall
X-ray with lateral view MRI to differentially diagnose fracture between metastatic disease or myeloma
What risk factors would you suspect with spinal malignancy?
Age over 50, history of cancer (not a risk factor in isolation)
Which organs metastasized to the spine
PBKTL prostate breast kidney thyroid liver
What are signs and symptoms of spine metastasis
Severe pain that comes and goes
Night pain
Systematically unwell
Thoracic pain
Greater than 5% body loss over six months
Neurological signs
Spinal tenderness
Weird feeling in legs with altered sensations
Lab tests: ESR and hematocrit
What are the normal ranges for ESR
Under 50 years old: less than 15-20 Over 50 years old: less than 20-30
How much weight loss is suspicious of cancer?
weight loss of five per cent or more in six months
Risk factors for a spinal infection, what signs or symptoms would you see?
Risk factors: Immunosuppression, surgery, IV drug use, social environmental risk factors: homelessness, prison, or work exposure, tuberculosis history or recent or pre-existing infection
Signs and symptoms include: fatigue, spine pain, neuro symptoms, infection symptoms get worse instead of wax/waning wiht maliganacy
Differentiate between malignancy using ESR, see reactive proteins normal white count does not rule out a spinal infection
What are the four main treatment selections based off the treatment based classification for lower back pain
Traction
Specific Exercise
Stabilization
Manipulation
Which patients benefit from manipulation according to the CPG
No symptoms distal to the knee symptom
Onset <16 days low
Fab Q score <19
Lumbar hypomobility
Hip internal rotation >35° for at least 1 hip
Which patients benefit from Specific exercise according to the CPG
Directional preference
Symptoms that centralize or peripheralize with lumbar range of motion
Symptoms distal to butt
> 50 years old
Which patients benefit from Stabilization according to the CPG
Patients younger than 40 greater
General flexibility (postpartum SLR range of motion >91°
Instability catch or aberrant movement
+ Prone instability test
Which patients benefit from traction according to the CPG
Signs and symptoms of nerve root compression: Crossed SLR test
No movements centralize
Symptoms peripheralize with flexion AND extension
According to the treatment selection based on the lumbar TBC what is the cascade of events for intervention selection
Symptom modulation treatment criteria for selection
> movement control
> functional optimization
Which patients can be classified under the symptom modulation category for the lumbar interventions CPG
High Irritability
ODI greater than 40
7 out of 10 pain
High disability
Volatile symptoms
Which patients can be classified under the movement control category for the lumbar interventions CPG
Moderate Irritability
ODI greater than 21-40
3-6 out of 10 pain
moderate disability
stable symptoms
Which patients can be classified under the functional optimization category for the lumbar interventions CPG
low Irritability
ODI greater than 0-20%
1-3 out of 10 pain
low disability
Controlled symptoms
Which interventions are appropriate for the symptom modulation patient category
Directional preference
Manipulation mobilization
Traction
Active rest (encourage active participation without fearful wording pain under 24 hours is consideration for acuity)
Which interventions are appropriate for the movement control patient category
Sensory motor exercises
Stabilization exercises
Flexibility exercises
(think nerve glides)
Which interventions are appropriate for the functional optimization patient category
Strength and conditioning
work/sport specific exercises
aerobic exercise
general fitness
