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Flashcards in Lumbar Spine Deck (43)
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1

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

2

When should you suspect CA?

Age > 50

History of Cancer

Weight loss

Unrelenting night pain

Failure to improve

3

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

4

When should you suspect fracture for lower back pain?

Age >50
Trauma
Steroid use
Osteoporosis

5

When should you suspect cauda equina syndrome?

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

6

Presentation of cauda equina syndrome?

Bilateral sciatica

Bilateral lower extremity weakness

Saddle anesthesia

Sphincter dysfunction

Bowel / bladder dysfunction

7

What should you do if you suspect cauda equine?

MRI or CT STAT STAT neurosurgery consult

8

What should you do if you suspect fx?

X-ray

MRI or CT if x-ray inconclusive

9

What should you do if you suspect CA?

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

MRI or CT based upon initial work up results

10

What should you do if you suspect infection?

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

11

What is considered acute low back pain?

New onset low back pain of < 12 weeks duration

(90% have mechanical LBP with good px) `

12

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

Paravertebral spinal muscles

Facet joints

Ligamentous structures

13

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

14

How long does acute low back pain typically last?

most cases are self limiting

several days-4 wks

15

Tx of acute low back pain?

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

PT

16

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

4 weeks

unless there are red flags

17

What is lumbar radiculopathy?

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

18

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

based on the distribution

19

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)

20

SLR v. seated SLR

seated SLR helps determine pts who are malingering

21

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.

22

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

23

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

nonsurg: epidural

surg: lamintomy and discectomy, laminectomy

24

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

25

Clinical manifestations of lumbar spinal stenosis?

>50

insidious onset

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

+/- numbness/tingling

weakness is not common

26

Neuro exam seen with lumbar spinal stenosis?

usually norm

but minority will exhibit sensory changes

27

Presentation of neurogenic claudication?

Numbness, ache, sharp

Relief w/ sitting-flexed

Occasional atrophy

Occasional weakness

Back pain common

Limited spine ROM

28

Presentation of vascular claudication?

Cramp, tightness

Relief w/ standing

Bruit present

Pulses absent

Shiny skin

Hair loss

29

Dx studies to eval for lumbar spinal stenosis?

Radiographs
MRI

30

What is spondylolisthesis?

Forward translation of one vertebra on another

Often occurs during growth spurt