Flashcards in Lumbar Spine Deck (18):
How long should you wait to get an MRI for back pain?
6 weeks b/c most resolves on its own
What is the most common cause of lumbar back pain?
Acute lumbar strain
Acute lumbar pain
Type of pain
•Sudden, non-radicular pain
•Caused by injury to muscle, tendon, or ligaments, usually from a lifting or twisting injury.
•Diagnosis - H&P
•Treatment – ice / heat, 1-2 days bed-rest (longer is bad), NSAIDs, narcotics / muscle relaxants (avoid if possible), time, PT (trunk stabilization, core strengthening) only after pain has stopped.
Chronic low back pain
What should NOT be done?
•Usually due to degenerative changes in disk and facet joints. Analogous to OA. Related to obesity, poor core strength, poor posture, and repetitive loading activities.
• Treatments are active – aerobic exercise, PT, weight loss, px education.
• Passive treatments do NOT work – meds, massage, heat, injections, or braces
• Do NOT use surgery or narcotics.
Most common age for acute disc herniations
Myotome for hip flexion
Myotome for hip extension
Myotome for knee extension
Myotome for knee flexion
Myotome for dorsiflexion
Myotome for plantarflexion
Myotome for foot inversion
Myotome for foot eversion
Treating acute disc herniation
•80% resolve spontaneously in 6-10 weeks. Begin PT at time of diagnosis.
•Walk for exercise (aerobic).
•Meds: NSAIDs, gabapentin, medrol
•Epidural steroid injections don’t stop herniation but reduces inflammation / pain
•Bed rest is NOT recommended.
•Consider surgical discectomy at 2-3 months if no pain relief. Surgery makes recovery faster, but long-term there isn’t much difference.
Absolute / relative indications for surgery after acute disc herniation
•Absolute: cauda equina syndrome or advancing progressive neurologic deficit
•Relative: intractable pain for >2 months, nerve root deficit (weakness / numbness), functional limitations, inability to sleep
Epidemiology: age, gender
•Caused by degenerative facet joint hypertrophy (may lead to subluxation / spondylolisthesis), disk degeneration, or ligamentum flavum hypertrophy.
•Pxs are usually age 40-80, women, and obese
•Sxs – Usually progress gradually. Pain w/ standing / walking (back, butt, thigh), neurogenic claudication, worse w/ extension.
• Sxs usually do not correlate w/ severity of MRI
• Gets better w/ sitting or forward flexion
•Treatment – PT, anti-inflammatory meds, epidural steroids, activity modification, weight loss, surgical decompression
Where do most cases of spondylolisthesis occur?
•Most occur during childhood (age 8-15). More common in athletes.
•Most spondylolysis cases are asymptomatic. Pain may be worse w/ extension and better w/ flexion.
•Diagnosis – history, LBP w/ L5 radiculopathy. Pain is worse w/ extension and better w/ flexion. PE shows palpable “step off” in lumbar spine. X ray is diagnostic.
• Initial – rest, NSAIDs, core strengthening, bracing, nerve root block
• Surgery for cases w/ persistent pain or worsening slip. Involves fusion b/w L5-S1