8. Diagnoses (low Back) That Cause Radicular Syndromes

Question 1

What is the A list for causes of lumbar radiculopathy?

Answer 1

• herniation

- stenosis

Question 2

What is the B list for causes of lumbar radiculopathy?

Answer 2

• SOL (tumor, cyst, etc)
• structural instability (AKA dynamic stenosis)
• Spondylolisthesis (unstable)
• NR adhesion
• fracture
• spinal infection
• osteophyte compression

Question 3

What is the C list for causes of lumbar radiculopathy?

Answer 3

• disc derangement
• facet syndrome
• joint dysfunction
• lumbalgia

Question 4

tumors causing leg symptoms are more common in what patients?

Answer 4

older patients (> 50-years old) or very young patients (< 10-years old).

Question 5

What are the most frequent primary
tumors to produce lumbosacral
radiculopathy?

Answer 5

Ependymomas or neurofibromas

Question 6

What are the three most likely cancers to

metastasize to the spine and cause LBP?

Answer 6

Breast, lung, prostate

Question 7

What percentage of metastases target lumbar spine

Answer 7

30%

Question 8

Of the metastases that target the lumbar spine, approximately how many of them will have radicular pain as the initial symptom?

Answer 8

50%

Question 9

What are some signs and symptoms associated with metastatic bone cancer of the lumbar spine?

Answer 9

• unremitting back pain (initial and most common complaint) that may be worse with recumbency
• weight loss, prior CA history, over 50
• radicular pain that is variable
• percussion tenderness
• • Valsalva

Question 10

How common are cysts in the sacral spine and are they symptomatic?

Answer 10

Fairly common in patients over 50 and usually asymptomatic

Question 11

If sacral cysts are symptomatic, what kind are they and why are they symptomatic?

Answer 11

Meningeal sacral dust and facet (synovial cysts) can compress nerve roots and cause radicular symptoms

Question 12

How common are spinal infections and who typically gets them?

Answer 12

Very uncommon
Typically occur in patients over 60 with complicating factors such as history of recurrent infection, DM, IV drug use, spinal injections, epidural catheter or otherwise immune compromised

Question 13

What is the clinical triad for infection spondylitis? What are some other symptoms?

Answer 13

Triad:

• Fever
• Back pain
• Neurologic deficits

NOTE: fever only present 2/3 of the time so cannot rule out if absent

Other symptoms:

• tender percussion
• leukocytosis
• endocarditis

Question 14

What imaging is indicated if infectious spondylitis is suspected?

Answer 14

MRI because X-ray can take up to 3 months to become positive

Question 15

How is the diagnosis of NR adhesions made?

Answer 15

By exclusion. Small adhesions are not visualized on X-ray

Question 16

Why should radicular syndromes attributed to facet syndrome, disc
derangement or joint dysfunction be a diagnosis by exclusion?

Answer 16

Because although NR can become chemically irritated, inflammed and symptomatic from these conditions, it is very unlikely and sever neurologic deficits would not be expected

Question 17

There can be extra spinal causes of sciatica that are not radicular. What are they?

Answer 17

• pelvic/gyn conditions such as endometriosis
• piriformis syndrome
• HZV
• HIV
• Lyme disease
• DM
• pregnancy/delivery
• trauma

Question 18

How often will Herpes zoster affect a spinal nerve causing symptoms into the lower
extremity?

Answer 18

5%

Question 19

What percentage of HIV/AIDS patients may present with signs of polyradiculopathy or
cauda equina syndrome?

Answer 19

2%

Question 20

Acute Lyme disease can occasionally mimic the radiculopathy

associated with _____

Answer 20

disc herniations.