Adv Lumbar Spine Part I - 2024 Flashcards
What is the lifetime incidence of low back pain, and lifetime prevalence?
lifetime incidence of LBP= 70-84%;
prevalence of chronic LBP is 2-25%
what’s the prognosis for acute LBP (<3 months)?
For acute LBP <3 months, the prognosis is good. Most recover FULLY within a year
-disability often improves prior to complete pain resolution
-high recurrence rate both short and long term
-imaging not indicated unless red flags are pesent
-acute LBP is a red flag if it doesn’t look MSK
what’s the prognosis for chronic LBP (>3 months)?
-pts typically have comorbidities
-potential for central sensitization
-changes in lumbar muscles
-FAIR PROGNOSIS (~40% with full recovery at 1 year)
-accounts for most of the healthcare resources used for LBP
what role does the CNS have in chronic LBP?
- LBP assoc w/ a change (decrease) in grey matter volume– reduced association if control for age, mood disorders, pain meds, and pain phenotype.
–may cause altered pain perception and modulation - many of the regions with altered grey matter are assoc. w/ emotion and cognition
- sensory paths are altered: increased nociceptive paths, decreased inhibitory paths, increased temporal summation esp at the pain location
- The brain can change to look more like those without LBP as a person experiences effective intervention (still foudn after controlling for depression)
How to measure sensory changes in chronic LBP?
- 2-point discrimination specifically at the region of pain is impaired in chronic LBP, and improves in those who respond well to tx
-proprioception (position sense) is often impaired
-those w chronic LBP have lower pain thresholds
How is motor control affected in LBP?
-Normally TA, and IO activate prior to extremity mvmt. Timing is altered in those with LBP, esp those with chronic LBP.
-Fatty infiltrates, muscle degeneration, inflammation, and impaired blood flow in the multifidi are found in those w chronic LBP more often than the general population…can affect segmental stability
-“smuding” of the brain map: chronic LBP showed overlapping areas of control for the deep paraspinals instead of separate areas
-short term mvmt adaptaion to avoid pain can persist after the initial tissue injury, causing reduction in mvmt variety and chronic tissue stress
What psychological indicators are poor prognoses for LBP?
- chronic LBP assoc w depression; depression is assoc w/ poor prognosis and can predict future LBP better than abnormal imaging
-pain catastrophizing is more related to disability than pain severity
-fear avoidance strongly correlated w/ disability
-stress is assoc w/ longer duration and higher severity of LBP
-STarT Back Screening Tool + Modified Oswestry able to adequately predict those who’d respond well to tx vs those who would still have a high lvl of disability
how good are pathoanatomical diagnoses for LBP?
LBP varies, and a single pathoanatomical cause is not clear
-pathology on imaging =/= pain
-clinical tests have limited use in ID’ing pathological issues, but can help with guiding tx
-look at whole picture
What are some pathoanatomical Dx’s related to LBP?
DDD, DJD, spinal stenosis, disc disruption/herniation (HNP), spondylolysis, spondylolisthesis, radiculopathy, strain/sprain, myofascial pain and referred pain, Fx, myelopathy, cauda equina syndrome, infextion, vascular conditions, malignancy, inflammatory spondyloarthropathies, autoimmune conditions, and more…
why use the ICF model?
use ICF model to connect potential pathoanatomical Dx’s to clinical patterns (impairments in body structure/function), relate impairments to functional limitations/participation restrictions, and address contextual factors
-these patterns guide assessment and tx; some pts fit many categories
what are the 2012 CPG categories, with regards to ICF classification?
LBP with mobility deficits
LBP with mvmt coord. impairments
LBP with related (referred) lower extremity pain —should not get hard neuro signs or positive Slump or SLR
LBP with radiating pain: SHOULD get hard neuro signs (myotomal, dermatomal, or DTR changes)
LBP with related cognitive or affective tendencies
LBP with related generalized pain
which tool to use to screen for red flags?
Optimal Screening for Prediction of Referral and Outcome (OSPRO).
-this was developed by George et al in 2015. 23 items that captured 100% of all those who had a red flag present
what are yellow flags?
psychosocial risk factors for the dvlpmt of chronic pain
- fear avoidance
- myhts about condition or activity
-pain catastrophizing
-hypervigilance
- depression
- social withdrawal
-More strongly assoc w/ a pt’s outcome than physical factors
-OSPRO-yellow flag dvlped to assess psychosocial factors. validated to aide in prognosis of pts with chronic LBP
what are orange flags?
orange= psychosocial sxs that are consistent w/ a psycholgical or psychiatric condition
what are blue flags?
blue= relate to those injured on the job- negative perception of work or effect of work on sxs can impair return to work
