Approach to Back Pain

Question 1

where do the cervical nerve come out

Answer 1

above the corresponding vetebral body

Question 2

symptoms for spondylosis

Answer 2

Episodic symptoms- acute pain generally improves

Exacerbated with extension

occipital HA common

Question 3

MC level for exacerbating spondylosis

Answer 3

C5-6 > C6-7

Question 4

whats the normal cord space*

Answer 4

> 17mm

Question 5

*C5 Radiculopathy: motor and sensory

Answer 5

Motor: Deltoid/Biceps
Reflex: Biceps

Question 6

*C6 Radiculopathy: motor and sensory

Answer 6

Motor: Biceps/Wrist extension
Reflex: Brachioradialis

Question 7

*C7 Radiculopathy: motor and sensory

Answer 7

Motor: Triceps/Wrist flexion
Reflex: Triceps

Question 8

*C8 Radiculopathy: motor and sensory

Answer 8

Motor: Finger flexion
Reflex: None

Question 9

*T1 Radiculopathy: motor and sensory

Answer 9

Motor: Finger Abduction
Reflex: None

Question 10

*which root is affected: Posterolateral C5-C6 herniation

Answer 10

affects C6

Question 11

*which root is affected: Foraminal stenosis C5-C6 herniation

Answer 11

affects C6

Question 12

*which root is affected: Large central to midlateral C5-C6 disk herniation

Answer 12

Primary C6 or if its really big C7 (can affect the subjacent level)

Question 13

*which root is affected: Posterolateral C7-T1 herniation

Answer 13

C8

Question 14

*what is the gold standard treatment for cervical radiculopathy

Answer 14

Anterior cervical decompression & fusion (ACDF)

Question 15

cervical myelopathy early presentation and what percent have associated lumbar stenosis

Answer 15

Clumsiness of hands and gait imbalance

20%

Question 16

what do you always do when there is a spinal cord injury

Answer 16

DRE, check for muscle tone

Question 17

cervical myelopathy cause

Answer 17

spinal cord compression rather than nerve root

Question 18

*what is the main goal of treating cervical myelopathy

Answer 18

STOP PROGRESSION
NOT symptom improvement
A lot of times the damage has already been done

Question 19

*90% of back pain resolves in…

Answer 19

1 yr

Question 20

*MC level for lumbar disk herniation

Answer 20

L5-S1 > L4-5

Question 21

*L1-3: motor and reflex

Answer 21

Motor: Hip Flexion (Iliopsoas)
Reflex: None

Question 22

• L4: motor and reflex

Answer 22

Motor: Knee extension/Foot dorsiflexion
Reflex: Patellar

Question 23

• L5: motor and reflex

Answer 23

Motor: Great toe extension
Reflex: None
Gait?
Trendelenburg (Glut medius innervated by L5)

Question 24

*S1 : motor and reflex

Answer 24

Motor: Foot Plantarflexion/Eversion
Reflex: Achilles

Question 25

Negative predictors for good outcome: discectomy

Answer 25

workers compensation

Question 26

lumbar spinal stenosis pts feel better when they…

Answer 26

lean over the cart