Lumbar Spine Flashcards

1
Q

What are some lumbar pain red flags?

A
Age < 15 or > 50
Assoc. fever / chills 
Trauma
Unrelenting night pain
Progressive sensory deficit
Neuro deficits
unexplained weight loss 
hx CA, osteoporosis, IV drug use, steroid use, immunosuppression, failure to improve after 6 wks
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2
Q

When should you suspect CA?

A

Age > 50

History of Cancer

Weight loss

Unrelenting night pain

Failure to improve

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3
Q

When should you suspect infection for cause of lumbar back pain?

A
IVDU
Steroid use
Fever/chills or T > 100.4° F
Unrelenting night pain
Failure to improve
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4
Q

When should you suspect fracture for lower back pain?

A

Age >50
Trauma
Steroid use
Osteoporosis

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5
Q

When should you suspect cauda equina syndrome?

A

Saddle anesthesia
Bowel/bladder dysfunction
Loss of sphincter control
Major motor weakness

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6
Q

Presentation of cauda equina syndrome?

A

Bilateral sciatica

Bilateral lower extremity weakness

Saddle anesthesia

Sphincter dysfunction

Bowel / bladder dysfunction

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7
Q

What should you do if you suspect cauda equine?

A

MRI or CT STAT STAT neurosurgery consult

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8
Q

What should you do if you suspect fx?

A

X-ray

MRI or CT if x-ray inconclusive

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9
Q

What should you do if you suspect CA?

A

X-rays + CRP, ESR, CBC (alk. phos.)

MRI or CT based upon initial work up results

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10
Q

What should you do if you suspect infection?

A

X-rays + CRP, ESR, CBC, +/- UA (alk. phos.)

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11
Q

What is considered acute low back pain?

A

New onset low back pain of < 12 weeks duration

(90% have mechanical LBP with good px) `

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12
Q

What are some injured/involved structures seen in acute low back pain?

A

Paravertebral spinal muscles

Facet joints

Ligamentous structures

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13
Q

What are some risk factors for acute low back pain

A
  • Age
  • Obesity
  • Physically strenuous work
  • Repeated twisting or bending
  • Job dissatisfaction
  • Prolong static posture
  • Anxiety / depression
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14
Q

How long does acute low back pain typically last?

A

most cases are self limiting

several days-4 wks

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15
Q

Tx of acute low back pain?

A
ice/heat 
stretching 
Meds: NSAIDs (Ketorolac) short course oral steroids, 
\+/-muscle relaxers,
\+/- Narcotics (try to avoid)

PT

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16
Q

In a pt presenting with acute low back pain, when should you order x-rays?

A

4 weeks

unless there are red flags

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17
Q

What is lumbar radiculopathy?

A

Dysfunction / irritation of a nerve root that causes: pain, sensory impairment, weakness, diminished deep tendon reflexes

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18
Q

How can you determine the involved nerve root of a lumbar radiculopathy?

A

based on the distribution

19
Q

Is sciatica the same as radiculopathy?

A

NO

radiculopathy is compression of a nerve root at the spinal cord level, causing problems at that level

sciatica is nerve related pain going down the back part of the pain (may be due to a radiculopathy)

20
Q

SLR v. seated SLR

A

seated SLR helps determine pts who are malingering

21
Q

What does supine leg raise evaluate?

A

Evaluate for sciatic nerve irritation or lumbar nerve root irritation

Reproduction of radicular pain with dorsiflexion is considered a positive test.

22
Q

What dx study should you order to eval in a pt with a one month hx of lumbar radiculopathy?

What therapeutics would you recommended?

A

xray, MRI

NSAIDs, steroids, PT

23
Q

In a pt with lumbar spine radiculopthy who has failed conservative tx, what can you try?

A

nonsurg: epidural
surg: lamintomy and discectomy, laminectomy

24
Q

What are some common spinal disorders in the aging population?

A

Disc degeneration

Arthritic changes involving lumbar vertebrae and facet joints

Thickening of the ligamentum flavum

25
Q

Clinical manifestations of lumbar spinal stenosis?

A

> 50

insidious onset

Low back pain & leg pain (morning stiffness, neuro claudication w/ walking, shopping cart sign)

+/- numbness/tingling

weakness is not common

26
Q

Neuro exam seen with lumbar spinal stenosis?

A

usually norm

but minority will exhibit sensory changes

27
Q

Presentation of neurogenic claudication?

A

Numbness, ache, sharp

Relief w/ sitting-flexed

Occasional atrophy

Occasional weakness

Back pain common

Limited spine ROM

28
Q

Presentation of vascular claudication?

A

Cramp, tightness

Relief w/ standing

Bruit present

Pulses absent

Shiny skin

Hair loss

29
Q

Dx studies to eval for lumbar spinal stenosis?

A

Radiographs

MRI

30
Q

What is spondylolisthesis?

A

Forward translation of one vertebra on another

Often occurs during growth spurt

31
Q

Grading of spondylolisthesis?

A

Grade 1 - < 25% translation

Grade 2 - < 50% translation

Grade 3 - < 75% translation

Grade 4 - < 100%

32
Q

Tx of lumbar spinal stenosis?

A

Acetaminophen, NSAIDs, Opioids

weight loss

PT

Epidural injections

Surg: laminectomy, fusion

33
Q

Positive stork test?

A

loads the facet region of the low back

balance/extent/rotate on both sides

(+) suggestive of spondylolysis

34
Q

What is spondylolysis?

A

Defect in the pars interarticularis of the lumbar vertebra

2-4x more likely in women

neuro sxs and radiculopathy rare

35
Q

Causes of sponylolysis?

A

Stress fracture of the pars interarticularis

Overloading of the pars interarticularis

Motions that overload: trunk extension and hyperextension, extension, rotation

36
Q

high risk sports for sponylolysis?

A
Classic ballet
Gymnastics
Figure skating
Football linemen
Diving
37
Q

Major concerns assoc. with sponylolysis?

A

Persistent pain

Risk of progression to spondylolisthesis

38
Q

How should you eval pt for sponylolysis?

A

Plain x-rays:
AP

Lateral – most sensitive
Spondylolisthesis

Lateral Oblique – most specific
“scotty dog” defect

39
Q

What if clinical presentation suggests sponylolysis but x-rays are negative?

A

consider stress reaction

-MRI, bone scan

40
Q

Etiology of stress reaction?

A

Repetitive mechanical stress (e.g. trunk extension & rotation)

41
Q

Pathology of stress rxn?

A

Absence of underlying bone pathology

Maladaptation to repetitive stress: osteoclast >osteoblst

production of microfxs, initiation of inflammatory response, bone stress injury > stress fx

42
Q

Grading of stress reactions?

A

Grade I: Periosteal edema

Grade II-III: Varying severity bone marrow edema

Grade IV: Cortical fracture line

43
Q

Tx of spondylolsis?

A

Activity restriction weeks 1 – 4

PT weeks 5 – 12

Gradual activity progression weeks 9 – 12

+/- Bracing

surg: grade III-IV