Lumbar Spine Conditions

Question 1

3 Categories of LBP

Answer 1

1. Serious Spinal Pathologies (tumors, infection, fx, cauda equina syndrome)
2. Sciatica
3. Nonspecific LBP (dysfunctions of msk tissues

Question 2

Term: Back-related LE symptoms caused by back (nerve/nerve root) conditions

Answer 2

Sciatica

Question 3

Distributions of LBP

1. Serious Spinal Pathologies
2. Sciatica
3. Nonspecific LBP

Answer 3

1. ~10%
2. ~40%
3. ~50(+)%

Question 4

Term: narrowing of the central canal or lateral intervertebral foramina

Answer 4

Spinal Stenosis

Question 5

Condition

• Male > Female
• 60+ yo
• Congenital or age related degeneration

Answer 5

Spinal Stenosis

Question 6

Term: Type of spinal stenosis most often due to degeneration

Answer 6

Lateral Spinal Stenosis

Question 7

Boundaries of the lateral foramen

• Anterior
• Posterior
• Superior

Answer 7

A: Vertebral body and disc

P: Ligamentum flavum

S: Facet joints

Question 8

Term: Neural compromise due to obstruction of blood flow to the nerve, nerve root, or dural sleeve

Answer 8

Neurogenic Claudication

Question 9

Condition: Symptoms

• Localized vauge pain
• Back and leg pain (can be bilateral)
• Presence of N/T and weakness in LEs
• Cramping

Answer 9

Spinal Stenosis

Question 10

Conditon: Aggravating Factors

• Extension
• Prolonged standing or walking
• Walking downhill
• Lying flat

** Anything that loads the posterior column **

Answer 10

Spinal Stenosis

Question 11

Condition: Easing Factors

• Flexion
• Sitting or squatting
• Walking uphill
• Bike riding

Answer 11

Spinal Stenosis

Question 12

Condition: Objective Exam

• Flat lumbar posture
• Painful/limited extension
• Pain with SB on involved side

Answer 12

Spinal Stenosis

Flat back posture unload the posterior column

Question 13

Term: Compromised ciculatory system due to PVD

Answer 13

Vascular Cluadication

Question 14

Condition: Pain worse with incline walking but improved with decline walking

Answer 14

Vascular Claudication

Question 15

Condition: Symptoms

• Flexion does not ease symtpoms
• Rarely have back sx

Answer 15

Vascular Claudication

Question 16

Condition: Objective Exam

• Skin color or temperature changes
• Hair loss
• Peripheral pulses absent
• LE cramping/tightness

Answer 16

Vascular Claudication

Question 17

Describe how the lumbar facet joints project the discs

Answer 17

Because they are oriented to prevent rotation

Question 18

Describe what motions cause facet compression

Answer 18

Lateral flexion and rotation

Question 19

Nerve: Innervates the lumbar facet joints

Answer 19

Medial branch of the dorsal primary ramus

Question 20

Describe the connection between LBP and mutlifidus atrophy

Answer 20

The medial branch of the dorsal primary ramus innervates the facet joints as well as multifidus.

The facet joint capsules are highly innervate and are a large source of LBP

When the facet joints are aggravated the body avoids activities that would worsen the pain, less firing of those nerves means less activity in multifidus leading to atrophy

Question 21

Structure: Synovial fold within facet joints

Answer 21

Meniscoid

Question 22

2 Functions of the Meniscoid

Answer 22

1. Provide smooth gliding motion
2. Prevent excess motion

Question 23

Cause of Acute Facet Joint

Answer 23

Mechanical block from meniscoid

Question 24

Condition: Symptoms

• Unilateral pain, sharp over facet
• Increased pain with stretch/compression of joint
• Limitation in SB and extension

Answer 24

Acute Facet Joint

Question 25

Condition: MOI of sudden unguarded movement (i.e. flexion or rotation)

Answer 25

Acute Facet Joint

Question 26

5 Causes of Chronic Facet Joint

Answer 26

1. Degerenation 2. Hypertrophy 3. Osteophytes 4. Inflammation 5. Microfracture

Question 27

Condition: Symptoms - Unilateral pain - Less sharpt over the joint - Rarely radiates down leg

Answer 27

Chronic Facet Joint

Question 28

Condition: Symptoms - Stiffness and pain in AM - Increased pain with stretch of joint

Answer 28

Chronic Facet Joint

Question 29

Condition: History - Past Acute Facet Joint - Never entirely symptom free - Trauma - Degeneration

Answer 29

Chronic Facet Joint

Question 30

Condition: Objective - Localized pain but can refer to larger area - Local tenderness with palpation, stiff, thick - Initially hypomoble

Answer 30

Chronic Facet Joints

Question 31

3 Things to Know about Facet Joints and Referred Pain

Answer 31

1. Facet joint have a referral pattern 2. The referral pattern becomes broad with facet joint pathology 3. The referral pattern is similar to many other LBP referrals

Question 32

Condition: Irritation/Inflammation, compression, or tension to the nerve root

Answer 32

Acute Nerve Root (ANR)

Question 33

3 Possible Causes of ANR

Answer 33

1. Disc pathologies 2. Degenerative changes 3. Other medical conditions

Question 34

Describe the progression of pain with ANR

Answer 34

Can begin as a proximal ache and them move distally

Question 35

Condition: Symptoms - More distal than proximal signs i.e. radiating - Limited ROM and activity - Muscloskeletal involement is central/local

Answer 35

ANR

Question 36

Condition: Chronic irritation of nerve root/adhesion

Answer 36

Chornic Nerve Root (CNR)

Question 37

4 Possible Causes of CNR

Answer 37

1. Hx of disc pathology 2. NR injury 3. Degenerative changes 4. Spinal surgery/scaring

Question 38

Condition: Symptoms - More proximal than distal - Minimal limitation of activity

Answer 38

CNR

Question 39

Condition: Objective - Localized thickness in tissues - Stiff segmentally - May report pain with OP

Answer 39

CNR