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Msk Spine > (2) Lumbar Spine Pathologies > Flashcards

(2) Lumbar Spine Pathologies Flashcards

1
Q

What is the diagnostic triage of lower back pain?

A
  • Specific spinal pathology
  • Radicular syndrome(s)
  • Non-Specific LBP
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2
Q

What are red flags for lower back pain?

A
  • Altered loss bladder/bowel control
  • malignancy
  • vertebral #
  • spinal infection (unrelenting pain)
  • 5 D’s (dizziness, double vision, dysarthria, dysphagia, drop attacks)
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3
Q

What are examples of non-specific LBP?

A
  • Disc strain
  • Facet joint
  • Spondylosis
  • Spondylolysis
  • Spondylothesis
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4
Q

What is intervertebral disc pain?

A
  • inflammation and tissue ischaemia
  • collagen
    changes/degrades
  • +/- annular tears
  • loss water content
  • > male
  • 90% L4/5
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5
Q

What are the four stages of intervertebral disc injury?

A
  • Bulging disc
  • Protrusion
  • Extrusion
  • Sequestration
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6
Q

What can be seen clinically in a patient with intervertebral disc injury?

A
  • hx bending & twisting
  • agg: lift, bend, cough, prolonged sitting
  • ease: lying, standing
  • o/e: worst pain on flexion
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7
Q

What is lumbar radiculopathy?

A
  • aka sciatica
  • pain down entire affected leg
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8
Q

What causes lumbar radiculopathy?

A
  • bulging disc
  • nerve root impingement
  • disc herniation
  • degenerative changes
  • tumor
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9
Q

What are symptoms of lumbar radiculopathy?

A
  • +ve SLR
    3 out of 4:
  • dermatomal pain distribution
  • sensory, motor or reflex changes
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10
Q

What is seen clinically in a patient with lumbar radiculopathy?

A
  • hx bending/twisting
  • agg: lift, bend, sitting
  • ease: lying, standing
  • o/e: antalgic, decreased ROM, +/- dermatomes, myotomes & reflexes, +ve SLR
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11
Q

How do you differentiate with the patient whether it is disc or nerve pain?

A
  • ask which is worse, leg or back pain
  • rate each out of 100
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12
Q

What is Facet Joint Syndrome?

A

It is an irritated facet joint

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13
Q

What is seen clinically in a patient with facet joint syndrome?

A
  • unilateral predominance
  • pseudo-radicular pain distribution
  • pain on extension/ipsilateral lat flexion
  • muscle imbalance
  • pain on palpation
  • agg: standing, walking
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14
Q

What is a facet joint block?

A

An injection of local anesthetic and steroids into the joint

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15
Q

What is Spondylosis?

A

It is a degenerative LBP/disc disease (OA)

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16
Q

What causes spondylosis?

A
  • degenerative disc, facet joint, vertebral body
  • ageing and genetics
  • micro trauma
  • annular tears
  • osteophytes
  • narrowing disc space
17
Q

What can be seen clinically in a patient with spondylosis?

A
  • pain & stiff
  • limited extension & lateral flexion
  • local pain on palpation
  • agg: standing & walking
18
Q

What is Lumbar Spine Stenosis?

A

Narrowing of the opening in the lower spine

19
Q

What causes lumbar spine stenosis?

A
  • narrowing spinal canal
  • compression spinal nerves
  • disc herniation
20
Q

What can be seen clinically in a patient with lumbar spine stenosis?

A
  • bilateral leg symptoms
  • pain on walking
  • improved walking gait with stooped posture
  • LL weakness
  • pain lower back, buttocks, posterior thighs
21
Q

What is spondylolysis?

A

It is a defect/stress in the pars interarticularis of the posterior vertebral arch

22
Q

What causes spondylolysis?

A

repetitive stress/loads

23
Q

What can be seen in a patient with spondylolysis?

A
  • usually young athletes
  • asymptomatic > symptomatic
  • L5 level
  • LBP standing and walking
  • decreased ROM
24
Q

What is spondylothesis?

A

Is a bilateral pars interarticularis defect in which one vertebra slips forward

25
Q

What are the 5 types of Spondylothesis?

A

I - dysplastic facets
II - stress/acute fracture
III - degenerative facet OA
IV - acute fracture of posterior
V - pathological

26
Q

What are clinical signs of spondylothesis?

A
  • Intervertebral slip/stop by palpation
  • segmental hypermobility
  • +ve low midline sill sign
27
Q

What is the treatment for spondylolysis and spondylothesis?

A

Conservative:
- advice + education
- analgesia
- exercise rehab, ‘core stability’
Surgical
- direct repairs
- fusions

28
Q

What is a rehab protocol for spondylolysis and spondylothesis?

A

WK 4-12
- ROM & low impact aerobic
- Neutral spine stabilizers
WK 8-16
- ROM & aerobic
- Resistive strength
- progressive spine stabilization
- access kinetic chain
WK 8 >
- aerobic & strength
- dynamic stabilization
- sport retraining
- skill and technique refinement

29
Q

What is ankylosing spondylitis?

A
  • Spondyloarthropathy
  • Inflammatory back pain
  • systemic rheumatic disease
30
Q

What causes ankylosing spondylitis?

A
  • enthesitis (inflammation of sites where tendons/ligs insert onto bone)
  • ageing
31
Q

What are the clinical signs for ankylosing spondylitis?

A

4 out of the following:
- gradual onset <40yrs
- Improved with exercise
- not improved with rest
- night pain/waking
- morning stiffness >1hr

32
Q

What is chronic lower back pain?

A

Non-specific label for lower back pain >3 or 6/12

33
Q

What causes chronic LBP?

A
  • lifting
  • smoking
  • obesity
  • depression
  • genetics
34
Q

What are some common yellow flags?

A
  • attitudes and beliefs
  • behaviours
  • compensation issues
  • diagnosis and treatment
  • emotions
  • family
  • work

Msk Spine (9 decks)

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