(2) Lumbar Spine Pathologies Flashcards
What is the diagnostic triage of lower back pain?
- Specific spinal pathology
- Radicular syndrome(s)
- Non-Specific LBP
What are red flags for lower back pain?
- Altered loss bladder/bowel control
- malignancy
- vertebral #
- spinal infection (unrelenting pain)
- 5 D’s (dizziness, double vision, dysarthria, dysphagia, drop attacks)
What are examples of non-specific LBP?
- Disc strain
- Facet joint
- Spondylosis
- Spondylolysis
- Spondylothesis
What is intervertebral disc pain?
- inflammation and tissue ischaemia
- collagen
changes/degrades - +/- annular tears
- loss water content
- > male
- 90% L4/5
What are the four stages of intervertebral disc injury?
- Bulging disc
- Protrusion
- Extrusion
- Sequestration
What can be seen clinically in a patient with intervertebral disc injury?
- hx bending & twisting
- agg: lift, bend, cough, prolonged sitting
- ease: lying, standing
- o/e: worst pain on flexion
What is lumbar radiculopathy?
- aka sciatica
- pain down entire affected leg
What causes lumbar radiculopathy?
- bulging disc
- nerve root impingement
- disc herniation
- degenerative changes
- tumor
What are symptoms of lumbar radiculopathy?
- +ve SLR
3 out of 4: - dermatomal pain distribution
- sensory, motor or reflex changes
What is seen clinically in a patient with lumbar radiculopathy?
- hx bending/twisting
- agg: lift, bend, sitting
- ease: lying, standing
- o/e: antalgic, decreased ROM, +/- dermatomes, myotomes & reflexes, +ve SLR
How do you differentiate with the patient whether it is disc or nerve pain?
- ask which is worse, leg or back pain
- rate each out of 100
What is Facet Joint Syndrome?
It is an irritated facet joint
What is seen clinically in a patient with facet joint syndrome?
- unilateral predominance
- pseudo-radicular pain distribution
- pain on extension/ipsilateral lat flexion
- muscle imbalance
- pain on palpation
- agg: standing, walking
What is a facet joint block?
An injection of local anesthetic and steroids into the joint
What is Spondylosis?
It is a degenerative LBP/disc disease (OA)
What causes spondylosis?
- degenerative disc, facet joint, vertebral body
- ageing and genetics
- micro trauma
- annular tears
- osteophytes
- narrowing disc space
What can be seen clinically in a patient with spondylosis?
- pain & stiff
- limited extension & lateral flexion
- local pain on palpation
- agg: standing & walking
What is Lumbar Spine Stenosis?
Narrowing of the opening in the lower spine
What causes lumbar spine stenosis?
- narrowing spinal canal
- compression spinal nerves
- disc herniation
What can be seen clinically in a patient with lumbar spine stenosis?
- bilateral leg symptoms
- pain on walking
- improved walking gait with stooped posture
- LL weakness
- pain lower back, buttocks, posterior thighs
What is spondylolysis?
It is a defect/stress in the pars interarticularis of the posterior vertebral arch
What causes spondylolysis?
repetitive stress/loads
What can be seen in a patient with spondylolysis?
- usually young athletes
- asymptomatic > symptomatic
- L5 level
- LBP standing and walking
- decreased ROM
What is spondylothesis?
Is a bilateral pars interarticularis defect in which one vertebra slips forward
What are the 5 types of Spondylothesis?
I - dysplastic facets
II - stress/acute fracture
III - degenerative facet OA
IV - acute fracture of posterior
V - pathological
What are clinical signs of spondylothesis?
- Intervertebral slip/stop by palpation
- segmental hypermobility
- +ve low midline sill sign
What is the treatment for spondylolysis and spondylothesis?
Conservative:
- advice + education
- analgesia
- exercise rehab, ‘core stability’
Surgical
- direct repairs
- fusions
What is a rehab protocol for spondylolysis and spondylothesis?
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
What is ankylosing spondylitis?
- Spondyloarthropathy
- Inflammatory back pain
- systemic rheumatic disease
What causes ankylosing spondylitis?
- enthesitis (inflammation of sites where tendons/ligs insert onto bone)
- ageing
What are the clinical signs for ankylosing spondylitis?
4 out of the following:
- gradual onset <40yrs
- Improved with exercise
- not improved with rest
- night pain/waking
- morning stiffness >1hr
What is chronic lower back pain?
Non-specific label for lower back pain >3 or 6/12
What causes chronic LBP?
- lifting
- smoking
- obesity
- depression
- genetics
What are some common yellow flags?
- attitudes and beliefs
- behaviours
- compensation issues
- diagnosis and treatment
- emotions
- family
- work
