Lumbar Spine Flashcards
(43 cards)
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
How can you determine the involved nerve root of a lumbar radiculopathy?
based on the distribution
Is sciatica the same as radiculopathy?
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)
SLR v. seated SLR
seated SLR helps determine pts who are malingering
What does supine leg raise evaluate?
Evaluate for sciatic nerve irritation or lumbar nerve root irritation
Reproduction of radicular pain with dorsiflexion is considered a positive test.
What dx study should you order to eval in a pt with a one month hx of lumbar radiculopathy?
What therapeutics would you recommended?
xray, MRI
NSAIDs, steroids, PT
In a pt with lumbar spine radiculopthy who has failed conservative tx, what can you try?
nonsurg: epidural
surg: lamintomy and discectomy, laminectomy
What are some common spinal disorders in the aging population?
Disc degeneration
Arthritic changes involving lumbar vertebrae and facet joints
Thickening of the ligamentum flavum
