Lumbar Spine Flashcards
What are some lumbar pain red flags?
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
When should you suspect CA?
Age > 50
History of Cancer
Weight loss
Unrelenting night pain
Failure to improve
When should you suspect infection for cause of lumbar back pain?
IVDU Steroid use Fever/chills or T > 100.4° F Unrelenting night pain Failure to improve
When should you suspect fracture for lower back pain?
Age >50
Trauma
Steroid use
Osteoporosis
When should you suspect cauda equina syndrome?
Saddle anesthesia
Bowel/bladder dysfunction
Loss of sphincter control
Major motor weakness
Presentation of cauda equina syndrome?
Bilateral sciatica
Bilateral lower extremity weakness
Saddle anesthesia
Sphincter dysfunction
Bowel / bladder dysfunction
What should you do if you suspect cauda equine?
MRI or CT STAT STAT neurosurgery consult
What should you do if you suspect fx?
X-ray
MRI or CT if x-ray inconclusive
What should you do if you suspect CA?
X-rays + CRP, ESR, CBC (alk. phos.)
MRI or CT based upon initial work up results
What should you do if you suspect infection?
X-rays + CRP, ESR, CBC, +/- UA (alk. phos.)
What is considered acute low back pain?
New onset low back pain of < 12 weeks duration
(90% have mechanical LBP with good px) `
What are some injured/involved structures seen in acute low back pain?
Paravertebral spinal muscles
Facet joints
Ligamentous structures
What are some risk factors for acute low back pain
- Age
- Obesity
- Physically strenuous work
- Repeated twisting or bending
- Job dissatisfaction
- Prolong static posture
- Anxiety / depression
How long does acute low back pain typically last?
most cases are self limiting
several days-4 wks
Tx of acute low back pain?
ice/heat stretching Meds: NSAIDs (Ketorolac) short course oral steroids, \+/-muscle relaxers, \+/- Narcotics (try to avoid)
PT
In a pt presenting with acute low back pain, when should you order x-rays?
4 weeks
unless there are red flags
What is lumbar radiculopathy?
Dysfunction / irritation of a nerve root that causes: pain, sensory impairment, weakness, diminished deep tendon reflexes