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Flashcards in Lumbar Spine Deck (18):

spondy terminology

- spondylosis: osteoarthritis of the spine
- spondylolyis "lysis": a crack stress fracture, also called a pars stress reaction
- sondylolisthesis: the stress fracture worsens, the vertebral body slips forward off the vertebral below (ex: L4 moving on L5)


Wiltses classification

- dysplastic: congenital abnormally of upper sacrum (sacral facets are short)
- spondylolytic: a pars lesion (may be a little thinner than normal)
- degenerative: pars, facet instability
- traumatic, non pars fracture: contact collision sports
- pathologic: from bony tumor


pars interarticularis breaks

- high prevalence in football and gymnastics
- mainly from hyperextension
- causes: repetitive fored lumbar hyperextension, sudden growth spurt, abrupt increase training intensity, improper technique, poor posture


diagnosing spondylolisthesis

- history, step deformity, referred pain, shortened stride, neurological involvement in grade 2 or >, imaging tests (bone scan)
- below kneeL nerve pain
- above knee: referred pain normally


treatment of pars stress rxn

- positive bone scan with negative radiograph
- restricted activity to pain free limit of motion
- minimum of 4-6 weeks conditioning post bracing


treatment grades 1 and 2 slippage

- immobilization with a torso brace followed by same progression last slide for pars.
- grade 3. 4. conservative approach (bracing) first if there are minimal neurological signs & symptoms, have to decide if surgery is needed


spinal stenosis

- narrowing of the spinal canal, nerve root canals, or vertebral foramen
- central: results in myelopathy (spinal cord compression) or cuada equina syndrom
- lateral: results in radiculopathy (nerve root compression, PNS problem)


lumbar spinal stenosis

- narrowing of lumbar canal
- congenital stenosis: up and down whole spinal cord and not knowing it, asymptomatic
- acquired stenosis: started life with space but over time space between foramen closed
- can happen from osteophytes, hypertrophied ligamentum flavum, hypertrophied facets, centrally herniated disc, latrogenic, tumor


how does spinal stenosis appear

- degenerative changes are most common cause of LSS
- facet hypertrophy, buckling of ligamentum flavum
- other causes; disc bulge, osteophytes


lumbar stenosis diagnosis

- history
- claudicant pain: leg pain that comes on when standing and asking and relieved by sitting
- relief in flexion, pain in extension
- hyper or hypo DTR
- lower extremity sensory loss
- lower extremity weakness
- possible bowel/bladder
- saddle area numbness
- imaging


lumbar nerve root impingement

- lumbar radiculopathy: irritation of one or more lumbar nerve roots due to compression
- most common roots involved are L5 and S1
- most frequent cause is a herniated or ruptured disk
- other causes: facet arthritis, local inflammation, tumor


lumbar radiculopathy

- causes of disc injury: poor posture (flat back, posterior pelvic tilt), obesity, smoking, occupation, improper lifting, vibration, repetitive compression


clinical presentation of lumbar radiulopathy

- complaint of lower back
- complaint of radicular pain
- loss of sensation in a dermatomal pattern
- lower extremity weakness (myotome)
- pain worsens with sneeze or cough
- intolerance to sitting
- flexion or extension pain pattern (most commonly it will be flexion)


lumbar radiculopathy diagnosis

- history
- neuro screen: dermatomal involvement, myotomal weakness, diminished deep tendon reflex, well SLR test
- possible lateral shift
- positive imaging tests


Straight Leg raise & well SLR test

- between 35-70 degrees of hip flexion look for reproduction of led pain, pareesthesias, burning sensation
- well at 95% specific. if negative, still could be a dis problem
- SLR has high sensitivity


disc herniation classification:

- protrusion: mild bulge, outstretching of posterior aspect of annulus.
- S&S: instability, ligamentous pain, occasional leg pain
- treatment: postural correction, McKenzie approach may work with this type, stabilization exercises, correct poor mechanics in sport, change behaviors


disc herniation classification:

- S&S: similar to protrusion, only now leg pain may be more frequent and neurological signs may be present
- dermatome, myotome, DTR-would deminish
- FB or BB may increase symptoms
- treatment: determine what movements make leg pain better or worse, posture will need correction, stabilization exercises when tolerable, endurance exercises


disc herniation classification:

- annulus torn, nucleus starting to escape
- S&S: worse in sitting, FB or BB may increase leg pain, neuro S&S present, possible lateral shift, significant disability
- treatment: McKenzie extension test, work on decreasing symptoms first, back pain second, correct posture